Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage

被引:174
|
作者
Parekh, N [1 ]
Venkatesh, B [1 ]
Cross, D [1 ]
Leditschke, A [1 ]
Atherton, J [1 ]
Miles, W [1 ]
Winning, A [1 ]
Clague, A [1 ]
Rickard, C [1 ]
机构
[1] Royal Brisbane Hosp, Herston, Qld 4029, Australia
关键词
D O I
10.1016/S0735-1097(00)00857-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES We studied the incidence of myocardial injury in aneurysmal subarachnoid hemorrhage (SAH) using the more sensitive cardiac troponin I (cTnI) assay, correlated changes in cTnI with creatine kinase, MB fraction (CK-MB), myoglobin, and catecholamine metabolite assays, and examined the predictive value of changes in cTnI for myocardial dysfunction. BACKGROUND Myocardial injury in aneurysmal SAH as evidenced by elevated CK-MB fraction has been reported. Little published data exist on the value of cTnI measurements in aneurysmal SAH. METHODS Thirty-nine patients were studied for seven days. Clinical cardiovascular assessment, electrocardiographic (ECG), echocardiography, cTnI, CK, CK-MB and CK-MB index, myoglobin and 24-h urinary catecholamine assays were performed in all patients. The ECG abnormalities were defined by the presence of ST-T changes, prolonged QT intervals, and arrhythmias. An abnormal echocardiogram was defined by the presence of wall-motion abnormalities and a reduced ejection fraction. The severity of SAH was graded clinically and radiologically. RESULTS Eight patients demonstrated elevations in cTnI (upper limit of normal is 0.1 mu g/liter with the immunoenzymatic assay and 0.4 mu g/liter with the sandwich immunoassay), while five had abnormal CK-MB levels (upper limit of normal is 8 mu g/liter). Patients with more severe grades of SAH were more Likely to develop a cTnI leak (p < 0.05). Patients with cTnI elevations were more likely to demonstrate ECG abnormalities (p < 0.01) and manifest clinical myocardial dysfunction (p < 0.01) as evidenced by the presence of a gallop rhythm on auscultation and clinical or radiological evidence of pulmonary edema as compared to those with CK-MB elevations. The sensitivity and specificity of cTnI to predict myocardial dysfunction were 100% and 91%, respectively, whereas the corresponding figures for CK-MB were 60% and 94%, respectively. Elevations in myoglobin levels (upper limit of normal <70 mu g/iiter) and urinary catecholamine metabolites (urinary vanilmandelate/creatinine ratio upper limit of normal, 2.6) are a nonspecific finding. CONCLUSIONS Measurements of cTnI reveal a higher incidence of myocardial injury than predicted by CK-MB in aneurysmal SAH, and elevations of cTnI are associated with a higher incidence of myocardial dysfunction. Thus, cTnI is a highly sensitive and specific indicator of myocardial dysfunction in aneurysmal SAH. (J Am Coll Cardiol 2000;36:1328-35) (C) 2000 by the American College of Cardiology.
引用
收藏
页码:1328 / 1335
页数:8
相关论文
共 50 条
  • [1] Cardiac Troponin I Elevation in Patients with Aneurysmal Subarachnoid Hemorrhage
    Jeon, Ik-Chan
    Chang, Chul-Hoon
    Choi, Byung-Yon
    Kim, Min-Su
    Kim, Sang-Woo
    Kim, Seong-Ho
    JOURNAL OF KOREAN NEUROSURGICAL SOCIETY, 2009, 46 (02) : 99 - 102
  • [2] Cardiac troponin 1 and myocardial injury as predictors of prognosis in aneurysmal subarachnoid hemorrhage
    Ramappa, P
    Marsh, J
    Carhuapoma, JR
    Gellman, S
    Atkinson, B
    Coplin, WM
    STROKE, 2004, 35 (06) : E320 - E320
  • [3] Prognostic Value of Elevated Cardiac Troponin I After Aneurysmal Subarachnoid Hemorrhage
    Lin, Fa
    Chen, Yu
    He, Qiheng
    Zeng, Chaofan
    Zhang, Chaoqi
    Chen, Xiaolin
    Zhao, Yuanli
    Wang, Shuo
    Zhao, Jizong
    FRONTIERS IN NEUROLOGY, 2021, 12
  • [4] Cardiac dysfunction after aneurysmal subarachnoid hemorrhage
    van der Bilt, Ivo
    Hasan, Djo
    van den Brink, Renee
    Cramer, Maarten-Jan
    van der Jagt, Mathieu
    van Kooten, Fop
    Meertens, John
    van den Berg, Maarten
    Groen, Rob
    ten Cate, Folkert
    Kamp, Otto
    Goette, Marco
    Horn, Janneke
    Groeneveld, Johan
    Vandertop, Peter
    Algra, Ale
    Visser, Frans
    Wilde, Arthur
    Rinkel, Gabriel
    NEUROLOGY, 2014, 82 (04) : 351 - 358
  • [5] The Use of Cardiac Troponin-I (cTnI) to Determine the Incidence of Myocardial Ischemia and Injury in Patients with Aneurysmal and Presumed Aneurysmal Subarachnoid Hemorrhage
    M.B. Horowitz
    D. Willet
    J. Keffer
    Acta Neurochirurgica, 1998, 140 : 87 - 93
  • [6] The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage
    Horowitz, MB
    Willet, D
    Keffer, J
    ACTA NEUROCHIRURGICA, 1998, 140 (01) : 87 - 93
  • [8] ELEVATED CARDIAC TROPONIN I AND FUNCTIONAL RECOVERY AND DISABILITY IN PATIENTS AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE
    Miketic, Joyce K.
    Hravnak, Marilyn
    Sereika, Susan M.
    Crago, Elizabeth A.
    AMERICAN JOURNAL OF CRITICAL CARE, 2010, 19 (06) : 522 - 529
  • [9] Cardiac troponin I predicts death and poor outcome after subarachnoid hemorrhage.
    Naidech, A
    Hurt, K
    Tamul, P
    Getch, C
    Stock, MC
    CRITICAL CARE MEDICINE, 2005, 33 (12) : A22 - A22
  • [10] Elevated Cardiac Troponin I and Relationship to Persistence of Electrocardiographic and Echocardiographic Abnormalities After Aneurysmal Subarachnoid Hemorrhage
    Hravnak, Marilyn
    Frangiskakis, J. Michael
    Crago, Elizabeth A.
    Chang, Yuefang
    Tanabe, Masaki
    Gorcsan, John, III
    Horowitz, Michael B.
    STROKE, 2009, 40 (11) : 3478 - 3484