The Relationships Between BNP and Neurocardiac Injury Severity, Noninvasive Cardiac Output, and Outcomes After Aneurysmal Subarachnoid Hemorrhage.
The Relationships Between BNP and Neurocardiac Injury Severity, Noninvasive Cardiac Output, and Outcomes After Aneurysmal Subarachnoid Hemorrhage.
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DOI：
10.1177/1099800417711584
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发表时间：
2017-10
影响因子：
2.5
通讯作者：
Yousef KM
中科院分区：
文献类型：
--
作者：
McAteer A;Hravnak M;Chang Y;Crago EA;Gallek MJ;Yousef KM
神经心脏损伤是一种与神经性脑损伤相关的心肌功能障碍，发生在31-48%的动脉瘤性蛛网膜下腔出血(ASAH)患者中。心肌肌钙蛋白I(CTnI)通常用于诊断神经心脏损伤。脑利钠肽(BNP)是另一种更常用于评估心力衰竭程度的心脏标志物。本研究的目的是研究脑钠素与ASAH患者a)cTnI神经心脏损伤严重程度、b)无创持续心输出量(NCCO)和c)预后的关系。这项描述性纵向研究纳入了30名成年ASAH患者。14天收集的数据包括BNP和cTnI水平，NCCO参数，以及出院时和3个月的结果(改良Rankin评分[MRS]和死亡率)。广义估计方程(GEE)评估了BNP与cTnI、NCCO和结果之间的关系。BNP升高与cTnI显著相关。对数BNP每增加1个单位，cTnI就增加0.05 ng/ml(p=.001)。BNP也与胸液含量显著相关(p=.0003)，但与其他NCCO参数无关。在多变量分析中，BNP和不良MRS之间存在显著的相关性。对于每1个单位的BNP，患者在出院时MRS差的可能性是3.16倍(p=.021)，在3个月时是5.40倍(p<；.0001)。BNP、cTnI与ASAH后不良预后有显著关系。BNP可能作为ASAH后神经心脏损伤和预后的潜在标记物。
Neurocardiac injury is a type of myocardial dysfunction associated with neurological insult to the brain and occurs in 31–48% of aneurysmal subarachnoid hemorrhage (aSAH) patients. Cardiac troponin I (cTnI) is commonly used to diagnose neurocardiac injury. Brain natriuretic peptide (BNP) is another cardiac marker more often used to evaluate degree of heart failure. The purpose of this study was to examine the relationships between BNP and a) neurocardiac injury severity according to cTnI, b) noninvasive continuous cardiac output (NCCO), and c) outcomes in aSAH patients. This descriptive longitudinal study enrolled 30 adult aSAH patients. Data collected for 14 days included BNP and cTnI levels, NCCO parameters, and outcomes (modified Rankin scale [mRS] and mortality) at discharge and three months. Generalized estimating equations (GEE) evaluated the associations between BNP and cTnI, NCCO, and outcomes. Elevated BNP was significantly associated with cTnI. For every 1 unit increase in log BNP, cTnI increased by 0.05 ng/ml (p = .001). BNP was also significantly associated with thoracic fluid content (p = .0003) but no other NCCO parameters. On multivariable analyses, significant associations were found between BNP and poor mRS. For every 1 unit log BNP, patients were 3.16 times more likely to have a poor mRS at discharge (p = .021) and 5.40 times more likely at 3 months (p < .0001). There was a significant relationship between BNP, cTnI, and poor outcomes after aSAH. BNP may have utility as a potential marker of neurocardiac injury and outcomes after aSAH.