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Cardiovascular Predictors of Intracerebral Hematoma Expansion
Khalid Sawalha1, Hera A Kamdar2, Terese Gullo2
1Department of Internal Medicine, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, United States.
Insights
Peripheral arterial disease and aortic stenosis may predict hematoma expansion in patients with intracerebral hemorrhage (ICH). Congestive heart failure showed a protective effect, suggesting novel cardio-cerebral links.
Area of Science:
- Cardiology
- Neurology
- Cerebrovascular Medicine
Background:
- Limited evidence exists on cardiovascular parameters affecting the cerebrovascular system during intracerebral hemorrhage (ICH).
- Conflicting studies suggest systolic cardiac function impacts ICH patient outcomes, with low ejection fractions linked to poor prognosis.
- Investigating cardiovascular disease states associated with hematoma expansion is crucial.
Purpose of the Study:
- To explore correlations between cardiovascular parameters and hematoma expansion in acute intracerebral hemorrhage.
- To identify specific cardiovascular disease states associated with increased or decreased hematoma expansion.
Main Methods:
- Retrospective, single-center study of adult patients with acute ICH and echocardiogram data.
- Utilized institutional "Get with the Guidelines"-Stroke registry (2013-2017).
- Employed univariate and multivariate logistic regression to identify predictors of hematoma expansion.
Main Results:
- Peripheral arterial disease (PAD) history, aortic stenosis (AS) on echocardiogram, and positive spot sign on CT-angiography were independently associated with ICH expansion.
- Hypertension history and presentation blood pressure were not significant predictors.
- Congestive heart failure history was associated with decreased odds of hematoma expansion.
Conclusions:
- Peripheral arterial disease and aortic stenosis may represent novel cardiac predictors of hematoma expansion in ICH.
- Congestive heart failure may have a protective effect against hematoma expansion.
- Further prospective studies are needed to validate these findings and optimize cardio-cerebral health.
Background:
There is limited evidence on the effect and relevance of cardiovascular parameters on the cerebrovascular system when an intracerebral hemorrhage (ICH) occurs. While recent studies evaluating this relationship are conflicting, one evaluating the effect of systolic cardiac function on clinical outcomes in ICH patients, found low cardiac ejection fractions to be associated with poor clinical outcomes. Our primary objective was to study such correlations and identify various cardiovascular disease states that may be associated with hematoma expansion.
Methods:
This is an IRB-approved single-center retrospective study utilizing our institutional "Get with the Guidelines"-Stroke registry between 2013 and 2017. Patients included were older than 18 years of age, admitted with an acute ICH, and had an echocardiogram during their hospitalization. Univariate and multivariate logistical regression analyses were used to identify cardiovascular predictors of hematoma expansion.
Results:
Two-hundred forty-nine patients were identified from our GWTG-S registry that met initial inclusion criteria. Of these patients, a history of peripheral arterial disease (PAD) (p = 0.015), presence of aortic stenosis (AS) on the echocardiogram (p = 0.025), and a positive spot sign on the CT-angiogram (CTA) of the head (p < 0.001) were found to be independently associated with ICH expansion. Both a history of hypertension and elevated blood pressure on presentation were not significant predictors. Additionally, patients with a history of congestive heart failure had decreased odds of hematoma expansion (p = 0.027).
Conclusion:
This exploratory study highlights potential novel cardiac predictors of hematoma expansion, including PAD and AS, which warrant further study. Larger prospective studies are needed to further investigate such associations to ultimately optimize cardio-cerebral health.
