Echocardiographic evaluation of neurocardiac injury in patients with aneurysmal subarachnoid hemorrhage: a prospective study
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摘要:
目的 应用超声心动图评价动脉瘤性蛛网膜下腔出血(aSAH)发生后早期及晚期心脏功能的变化。 方法 纳入2018年5月~2023年5月于首都医科大学附属北京中医医院确诊为aSAH的患者83例。按心肌肌钙蛋白(cTnI)水平将其分为高cTnI组(cTnI≥0.3 ng/mL, n=25)及低cTnI组(cTnI < 0.3 ng/mL, n=58)。超声心动图评价左室长轴应变及径向应变。分别计算得出整体长轴应变(GLS)及每个节段长轴应变达峰时间变异程度(LT-Dispersion)、每个节段径向应变达峰时间变异程度(RT-Dispersion)及乳头肌水平左室短轴切面左室前间隔与左室后壁径向应变达峰时间差值(APT)。 结果 发生后早期高cTnI组LT-Dispersion、RT-Dispersion、APT及GLS受损更为显著(P < 0.05);2组发生后晚期LT-Dispersion、RT-Dispersion、APT及GLS较发生后早期有明显改善(P < 0.05), 低cTnI组改善程度较高cTnI组更显著(P < 0.05)。 结论 GLS及反映左室局部运动不协调的指标LT-Dispersion、RT-Dispersion及APT与表现为cTnI升高的aSAH心脑损伤密切相关。超声心动图评价动脉瘤性蛛网膜下腔出血患者心脑功能损伤程度具有重要的临床应用价值。 Abstract:Objective To discuss changes in cardiac function from early stage after aneurysmal subarachnoid hemorrhage (aSAH) to shortly later stage using echocardiography. Methods We prospectively studied 83 patients with aSAH in Beijing Hospital of Traditional Chinese Medicine from May 2018 to May 2023. These patients were divided into the highly positive cTnI group (cTnI≥0.3 ng/mL, n=25) and the mildly positive cTnI group (cTnI < 0.3 ng/mL, n=58) according to cTnI level. Longitudinal strain and radial strain were acquired by strain echocardiography. Global longitudinal strain (GLS), the standard deviation of time-to-peak longitudinal strain from LV segments (LT-Dispersion), the standard deviation of time‑to‑peak radial strain from LV segments (RT‑Dispersion) and the time‑to‑peak radial strain difference between LV anterior septum and posterior wall in left ventricular short axis view at papillary muscle level (APT) were measured and calculated. Results At early stage, LT-Dispersion, RT-Dispersion, APT and GLS in highly positive cTnI group were associated with more serious neurocardiac damage than others (P < 0.05). Improvements (later stage vs early stage) of GLS, LT‑Dispersion, RT‑Dispersion and APT were more significantly better in the mildly positive cTnI group than in the highly positive cTnI group (P < 0.05). Conclusion GLS and left ventricular regional discoordination measured by LT-Dispersion, RT-Dispersion and APT were significantly associated with neurocardiac injury severity after aSAH as reflected by elevated cTnI. Novel echocardiographic analysis to detect neurocardiac injury severity in patients with aSAH has promise for clinical utility. -
Key words:
- subarachnoid hemorrhage /
- aneurysmal /
- neurocardiac injury /
- echocardiography
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图 1 2D-STI评价指标参考图
Figure 1. 2D-STI parameters references. A: LT-Dispersion (apical 4 chamber view), the standard deviation of time-to-peak longitudinal strain from 18 LV segments on 3 apical views; B: RT-Dispersion (left ventricular short axis view at papillary muscle level), the standard deviation of time-to-peak radial strain from 18 LV segments on 3 short axis views; C: APT, the time-to-peak radial strain differences between LV anterior septum and posterior wall on left ventricular short axis view at papillary muscle level.
表 1 两组患者的一般资料
Table 1. Baseline data between the two groups
Baseline data Mildly positive cTnI group (n=58) Highly positive cTnI group (n=25) P Age (years, Mean±SD) 50±10 57±13 0.06 Male [n(%)] 35(60) 15(59) 0.12 Hypertension [n(%)] 46(79) 21(84) 0.30 Fisher score [point, M(P25, P75)] 2 (2, 4) 3 (2, 4) 0.02 
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表 2 2组GLS、LT-Dispersion、RT-Dispersion及APT资料比较
Table 2. GLS、LT-Dispersion、RT-Dispersion and APT between two groups (Mean±SD)
Index Mildly positive cTnI group Highly positive cTnI group P (in groups) P (between groups) Early stage Late stage Early stage Late stage GLS (%) -16.49±1.33 -19.68±1.32 -15.79±1.43 -18.78±1.66 0.02 0.01 LT-Dispersion (ms) 52±9 48±3 61±11 42±10 0.02 0.02 RT-Dispersion (ms) 9±4 5±2 48±10 37±7 0.02 0.03 APT (ms) 3±3 1±1 33±11 18±6 0.03 0.04 GLS: Global longitudinal strain; LT-Dispersion: The standard deviation of time-to-peak longitudinal strain from LV segments; RT-Dispersion: The standard deviation of time-to-peak radial strain from LV segments; APT: the time-to-peak radial strain difference between LV anterior septum and posterior wall in left ventricular short axis view at papillary muscle level.
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表 3 2组WMSI、E/Ea及LVEF资料比较
Table 3. WMSI、E/Ea and LVEF between the two groups
Index Mildly positive cTnI group Highly positive cTnI group P (in groups) P (between groups) Early stage Late stage Early stage Late stage WMSI [point, M(P25, P75)] 1(1, 2) 1(1, 1) 1(1, 2) 1(1, 1) 0.04 0.10 E/Ea (point, Mean±SD) 10.94±4.10 10.10± 3.59 11.12± 5.31 10.34± 4.56 0.04 0.09 LVEF (%, Mean±SD) 54± 13 65±9 53±12 63±8 0.03 0.06 WMSI: Wall motion score index; E/Ea: E peak from mitral flow in pulse wave Doppler imaging/Ea peak from mitral annulus in tissue Doppler imaging; LVEF: Left ventricular ejection fraction.
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[1] 贾建平, 陈生弟. 神经病学[M]. 7版. 北京: 人民卫生出版社, 2013: 193-8. [2] Tung P, Kopelnik A, Banki N, et al. Predictors of neurocardiogenic injury after subarachnoid hemorrhage[J]. Stroke, 2004, 35(2): 548-51. doi: 10.1161/01.STR.0000114874.96688.54 [3] Frangiskakis JM, Hravnak M, Crago EA, et al. Ventricular arrhythmia risk after subarachnoid hemorrhage[J]. Neurocrit Care, 2009, 10(3): 287-94. doi: 10.1007/s12028-009-9188-x [4] Coghlan LA, Hindman BJ, Bayman EO, et al. Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial[J]. Stroke, 2009, 40(2): 412-8. doi: 10.1161/STROKEAHA.108.528778 [5] Yarlagadda S, Rajendran P, Miss JC, et al. Cardiovascular predictors of in-patient mortality after subarachnoid hemorrhage[J]. Neurocrit Care, 2006, 5(2): 102-7. doi: 10.1385/NCC:5:2:102 [6] Doshi R, Neil-Dwyer G. Hypothalamic and myocardial lesions after subarachnoid haemorrhage[J]. J Neurol Neurosurg Psychiatry, 1977, 40(8): 821-6. doi: 10.1136/jnnp.40.8.821 [7] Hravnak M, Frangiskakis JM, Crago EA, et al. Elevated cardiac troponin I and relationship to persistence of electrocardiographic and echocardiographic abnormalities after aneurysmal subarachnoid hemorrhage[J]. Stroke, 2009, 40(11): 3478-84. doi: 10.1161/STROKEAHA.109.556753 [8] Cinotti R, Piriou N, Launey Y, et al. Speckle tracking analysis allows sensitive detection of stress cardiomyopathy in severe aneurysmal subarachnoid hemorrhage patients[J]. Intensive Care Med, 2016, 42(2): 173-82. doi: 10.1007/s00134-015-4106-5 [9] Hestenes SM, Halvorsen PS, Skulstad H, et al. Advantages of strain echocardiography in assessment of myocardial function in severe sepsis: an experimental study[J]. Crit Care Med, 2014, 42(6): e432-40. doi: 10.1097/CCM.0000000000000310 [10] Dandel M, Hetzer R. Echocardiographic strain and strain rate imaging: clinical applications[J]. Int J Cardiol, 2009, 132(1): 11-24. doi: 10.1016/j.ijcard.2008.06.091 [11] Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain imaging by echocardiography: from technical considerations to clinical applications[J]. J Am Soc Echocardiogr, 2007, 20(3): 234-43. doi: 10.1016/j.echo.2006.08.023 [12] 中华医学会神经病学分会. 中国蛛网膜下腔出血诊治指南2015[J]. 中华神经科学杂志, 2016, 49(3): 182-91. [13] Cannesson M, Tanabe M, Suffoletto MS, et al. A novel two-dimensional echocardiographic image analysis system using artificial intelligence-learned pattern recognition for rapid automated ejection fraction[J]. J Am Coll Cardiol, 2007, 49(2): 217-26. doi: 10.1016/j.jacc.2006.08.045 [14] Tanabe M, Crago EA, Suffoletto MS, et al. Relation of elevation in cardiac troponin I to clinical severity, cardiac dysfunction, and pulmonary congestion in patients with subarachnoid hemorrhage[J]. Am J Cardiol, 2008, 102(11): 1545-50. doi: 10.1016/j.amjcard.2008.07.053 [15] Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging[J]. J Am Soc Echocardiogr, 2016, 29(4): 277-314. doi: 10.1016/j.echo.2016.01.011 [16] Kono T, Morita H, Kuroiwa T, et al. Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: Neurogenic stunned myocardium[J]. J Am Coll Cardiol, 1994, 24(3): 636-40. doi: 10.1016/0735-1097(94)90008-6 [17] Richard C. Stress-related cardiomyopathies[J]. Ann Intensive Care, 2011, 1(1): 39. doi: 10.1186/2110-5820-1-39 [18] Samuels MA. The brain-heart connection[J]. Circulation, 2007, 116(1): 77-84. doi: 10.1161/CIRCULATIONAHA.106.678995 [19] Dorn GW 2nd. Adrenergic signaling polymorphisms and their impact on cardiovascular disease[J]. Physiol Rev, 2010, 90(3): 1013-62. doi: 10.1152/physrev.00001.2010 [20] Horowitz MB, Willet D, Keffer J. 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[J]. Acta Neurochir, 1998, 140(1): 87-93. doi: 10.1007/s007010050063 [21] van den Bergh WM, Algra A, Rinkel GJE. Electrocardiographic abnormalities and serum magnesium in patients with subarachnoid hemorrhage[J]. Stroke, 2004, 35(3): 644-8. doi: 10.1161/01.STR.0000117092.38460.4F [22] Sommargren CE, Zaroff JG, Banki N, et al. Electrocardiographic repolarization abnormalities in subarachnoid hemorrhage[J]. J Electrocardiol, 2002, 35(Suppl): 257-62. -
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