Page 72 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Chapter 5
Abstract
Introduction: Cardiac dysfunction may occur after aneurysmal subarachnoid hemorrhage (aSAH). Although it is associated with poor outcome, the pathophysiological mechanism of this association remains unclear. We investigated the relationship between cardiac function and cerebral perfusion in patients with aSAH.
Methods: We studied 72 aSAH patients admitted within 72 hours after ictus with echocardiography and cerebral CT perfusion within 24 hours after admission. Cardiac dysfunction was defined as myocardial wall motion abnormalities or positive troponin. In patients with and without cardiac dysfunction, we calculated mean perfusion (cerebral blood flow (CBF) and time to peak (TTP)) in standard regions of interest and calculated differences with 95% confidence intervals (95%CI).
Results: In 35 patients with cardiac dysfunction minimal CBF was 15.83 mL/100g/ min compared to 18.59 in 37 without (difference of means: -2.76; 95%CI:-5.43 to -0.09). Maximal TTP was 26.94 seconds for patients with and 23.10 seconds for patients without cardiac dysfunction (difference of means: 3.84; 95%CI:1.63 to 6.05). Mean global CBF was 21.71 mL/100g/min for patients with cardiac dysfunction and 24.67 mL/100g/min for patients without cardiac dysfunction (-2.96; 95%CI:-6.19 to 0.27). Mean global TTP was 25.27 seconds for patients with cardiac dysfunction and 21.26 for patients without cardiac dysfunction (4.01; 95%CI:1.95 to 6.07). Conclusion: aSAH patients with cardiac dysfunction have decreased focal and global cerebral perfusion. Further studies should evaluate whether this relation is explained by a direct effect of cardiac dysfunction on cerebral circulation or by an external determinant, such as a hypercatecholaminergic or hypometabolic state, influencing both cardiac function and cerebral perfusion.
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