Left Ventricular Dysfunction and Cerebral Infarction from Vasospasm After Subarachnoid Hemorrhage
Left Ventricular Dysfunction and Cerebral Infarction from Vasospasm After Subarachnoid Hemorrhage
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DOI：
10.1007/s12028-010-9447-x
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发表时间：
2010-12-01
影响因子：
3.5
通讯作者：
Parra, Augusto
中科院分区：
文献类型：
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作者：
Temes, Richard E.;Tessitore, Elena;Parra, Augusto
尽管动脉瘤性蛛网膜下腔出血（SAH）后神经源性心肌顿抑（NSM）已得到充分描述，但其临床意义仍不明确。我们研究了左心室 (LV) 功能障碍和脑血管痉挛对脑梗塞、严重心血管事件和 SAH 后功能结局的影响。在 10/96 至 05/02 期间参加哥伦比亚大学 SAH 结果项目的 481 名患者中，我们分析了 119 名患者的子集，这些患者至少进行了一次超声心动图、连续经颅检查 多普勒 (TCD) 数据，并且既往无心脏病史。左心室功能障碍定义为超声心动图射血分数< 40%。研究小组在综合审查所有临床和影像学数据后判定血管痉挛引起的梗死。在第 15 天和第 90 天时使用改良 Rankin 量表 (mRS) 评估功能结果。11% 的患者存在左室功能障碍 (N = 13)。年龄较小、脑积水、四叠体和第四脑室完全充盈与左室功能障碍相关（均 P < 0.05）。尽管先前存在高血压的频率相似，但左室功能障碍患者中只有 0% 报告服用过抗高血压药物，而没有服用抗高血压药物的患者中这一比例为 35% (P = 0.009)。调整临床分级、年龄和 TCD 峰值流速后，左心室功能障碍与血管痉挛引起的梗塞之间存在显着相关性 (P = 0.03)。左心室功能不全的患者发生需要升压药的低血压 (P = 0.001) 和肺水肿 (P = 0.002) 的发生率也较高。然而，调整既定预后变量后，左室功能障碍与 14 天的结果之间没有关联。SAH 后的左室功能障碍会增加血管痉挛、低血压和肺水肿导致脑梗死的风险，但积极的 ICU 支持不会影响短期生存或功能结果。抗高血压药物可能具有心脏保护作用，并降低 SAH 后儿茶酚胺介导的损伤风险。
Although neurogenic stunned myocardium (NSM) after aneurysmal subarachnoid hemorrhage (SAH) is well described, its clinical significance remains poorly defined. We investigated the influence of left ventricular (LV) dysfunction and cerebral vasospasm on cerebral infarction, serious cardiovascular events, and functional outcome after SAH.Of the 481 patients enrolled in the University Columbia SAH Outcomes Project between 10/96 and 05/02, we analyzed a subset of 119 patients with at least one echocardiogram, serial transcranial Doppler (TCD) data, and with no prior history of cardiac disease. LV dysfunction was defined as an ejection fraction < 40% on echocardiography. Infarction from vasospasm was adjudicated by the study team after comprehensive review of all clinical and imaging data. Functional outcome was assessed at 15 and 90 days with the modified Rankin Scale (mRS).Eleven percent of patients had LV dysfunction (N = 13). Younger age, hydrocephalus, and complete filling of the quadrigeminal and fourth ventricles were associated with LV dysfunction (all P < 0.05). Despite a similar frequency of pre-existing hypertension, 0% of patients with LV dysfunction reported taking antihypertensive medication, compared to 35% of those without (P = 0.009). There was a significant association between LV dysfunction and infarction from vasospasm after adjusting for clinical grade, age, and peak TCD flow velocity (P = 0.03). Patients with LV dysfunction also had higher rates of hypotension requiring vasopressors (P = 0.001) and pulmonary edema (P = 0.002). However, there was no association between LV dysfunction and outcome at 14 days after adjustment for established prognostic variables.LV dysfunction after SAH increases the risk of cerebral infarction from vasospasm, hypotension, and pulmonary edema, but with aggressive ICU support does not affect short-term survival or functional outcome. Antihypertensive medication may confer cardioprotection and reduce the risk of catecholamine-mediated injury after SAH.