Abstract
Background
Intracranial hemorrhage (ICH) is often associated with cardiac events. Twelve-lead electrocardiography (ECG) and transthoracic echocardiography are essential diagnostic tools for preoperative risk assessment. B-type natriuretic peptide (BNP) is a well-known predictor of cardiac outcome in various clinical settings. This study examined whether BNP levels on admission are associated with in-hospital cardiac events among ICH patients.
Method
This prospective study enrolled 77 ICH patients who were admitted to this hospital for emergency neurosurgery. On admission, BNP levels, 12-lead ECG and transthoracic echocardiography were carried out for all patients. These patients were divided into two groups: Group I included 19 patients (10 men and 9 women) having 24 in-hospital cardiac events (mean age of 57 ± 15 years); Group II included 57 patients (29 men, mean age of 71 ± 11 years) without cardiac events.
Results
Admission BNP levels of Group I patients were significantly higher than those of Group II patients (683.8 ± 1,043.8 pg/ml vs 168.5 ± 173.5 pg/ml, p = 0.001). In multivariate analysis, BNP levels and T-wave inversion are independent predictors of in-hospital cardiac events. A cutoff value of BNP levels (156.6 pg/ml) predicted in-hospital cardiac events in ICH patients with 80 % sensitivity and 66 % specificity.
Conclusions
Serum BNP levels and electrocardiographic T-wave inversion on admission are independent predictors of in-hospital cardiac events in patients with ICH who undergo emergency neurosurgery.
Similar content being viewed by others
References
Burch GE, Meyers R, Abildskov JA (1954) A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation 9:719–723
Macmillan CS, Grant IS, Andrews PJ (2002) Pulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management? Intensiv Care Med 28:1012–1023
Crago EA, Kerr ME, Kong Y, Baldisseri M, Horowitz M, Yonas H, Kassam A (2004) The impact of cardiac complications on outcome in the SAH population. Acta Neurol Scand 110:248–253
Mayer SA, Lin J, Homma S, Solomon RA, Lennihan L, Sherman D, Fink ME, Beckford A, Klebanoff LM (1999) Myocardial injury and left ventricular performance after subarachnoid hemorrhage. Stroke 30:780–786
Tung P, Kopelnik A, Banki N, Ong K, Ko N, Lawton MT, Gress D, Drew B, Foster E, Parmley W, Zaroff J (2004) Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke 35:548–551
Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, Gorenek B, Hennerici MG, Iung B, Kelm M, Kjeldsen KP, Kristensen SD, Lopez-Sendon J, Pelosi P, Philippe F, Pierard L, Ponikowski P, Schmid JP, Sellevold OF, Sicari R, Van den Berghe G, Vermassen F (2009) Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J 30:2769–2812
de Lemos JA, Morrow DA, Bentley JH, Omland T, Sabatine MS, McCabe CH, Hall C, Cannon CP, Braunwald E (2001) The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 345:1014–1021
Doust JA, Glasziou PP, Pietrzak E, Dobson AJ (2004) A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure. Arch Intern Med 164:1978–1984
Makikallio AM, Makikallio TH, Korpelainen JT, Vuolteenaho O, Tapanainen JM, Ylitalo K, Sotaniemi KA, Huikuri HV, Myllyla VV (2005) Natriuretic peptides and mortality after stroke. Stroke 36:1016–1020
Tomida M, Muraki M, Uemura K, Yamasaki K (1998) Plasma concentrations of brain natriuretic peptide in patients with subarachnoid hemorrhage. Stroke 29:1584–1587
Tung PP, Olmsted E, Kopelnik A, Banki NM, Drew BJ, Ko N, Lawton MT, Smith W, Foster E, Young WL, Zaroff JG (2005) Plasma B-type natriuretic peptide levels are associated with early cardiac dysfunction after subarachnoid hemorrhage. Stroke 36:1567–1569
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I et al (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American society of echocardiography committee on standards, subcommittee on quantitation of Two-dimensional echocardiograms. J Am Soc Echocardiogr 2:358–367
Khouri SJ, Maly GT, Suh DD, Walsh TE (2004) A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr 17:290–297
Banki NM, Kopelnik A, Dae MW, Miss J, Tung P, Lawton MT, Drew BJ, Foster E, Smith W, Parmley WW, Zaroff JG (2005) Acute neurocardiogenic injury after subarachnoid hemorrhage. Circulation 112:3314–3319
Mertes PM, Carteaux JP, Jaboin Y, Pinelli G, el Abassi K, Dopff C, Atkinson J, Villemot JP, Burlet C, Boulange M (1994) Estimation of myocardial interstitial norepinephrine release after brain death using cardiac microdialysis. Transplantation 57:371–377
McGirt MJ, Blessing R, Nimjee SM, Friedman AH, Alexander MJ, Laskowitz DT, Lynch JR (2004) Correlation of serum brain natriuretic peptide with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage. Neurosurgery 54:1369–1373, discussion 1373-1364
Gerbes AL, Dagnino L, Nguyen T, Nemer M (1994) Transcription of brain natriuretic peptide and atrial natriuretic peptide genes in human tissues. J Clin Endocrinol Metab 78:1307–1311
Banki N, Kopelnik A, Tung P, Lawton MT, Gress D, Drew B, Dae M, Foster E, Parmley W, Zaroff J (2006) Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage. J Neurosurg 105:15–20
Zaroff JG, Rordorf GA, Ogilvy CS, Picard MH (2000) Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neurally mediated cardiac injury. J Am Soc Echocardiogr 13:774–779
Rodseth RNBB, Le Manach Y, Sessler DI, Lurati Buse GA, Thabane L, Schutt RC, Bolliger D, Cagini L, Cardinale D, Chong CP, Chu R, Cnotliwy M, Di Somma S, Fahrner R, Lim WK, Mahla E, Manikandan R, Puma F, Pyun WB, Radović M, Rajagopalan S, Suttie S, Vanniyasingam T, van Gaal WJ, Waliszek M, Devereaux PJ (2014) The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis. J Am Coll Cardiol 63:170–180
Spatenkova VBO, Kazda A, Suchomel P (2011) N-terminal pro-B-Type natriuretic peptided with fractional excretion and clearance of sodium in relation to cardiovascular events after elective cervical spine surgery. Neuro Endocrinol Lett 32:874–878
Di Pasquale G, Pinelli G, Andreoli A, Manini G, Grazi P, Tognetti F (1987) Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage. Am J Cardiol 59:596–600
Jung JH, Min PK, Rim SJ, Ha JW, Chung N, Lee KC (2010) Are electrocardiographic changes in patients with acute subarachnoid hemorrhage associated with Takotsubo cardiomyopathy? Cardiology 115:98–106
Khechinashvili G, Asplund K (2002) Electrocardiographic changes in patients with acute stroke: a systematic review. Cerebrovasc Dis 14:67–76
Andreoli A, di Pasquale G, Pinelli G, Grazi P, Tognetti F, Testa C (1987) Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. A survey of 70 cases studied in the acute phase. Stroke 18:558–564
Coghlan LA, Hindman BJ, Bayman EO, Banki NM, Gelb AW, Todd MM, Zaroff JG (2009) Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial. Stroke 40:412–418
Kawahara E, Ikeda S, Miyahara Y, Kohno S (2003) Role of autonomic nervous dysfunction in electrocardio-graphic abnormalities and cardiac injury in patients with acute subarachnoid hemorrhage. Circ J 67:753–756
Jensen JK, Korsholm L, Hoilund-Carlsen PF, Atar D, Kristensen SR, Mickley H (2007) The relation between electrocardiographic ST-T changes and NT-proBNP in patients with acute ischemic stroke. Scand Cardiovasc J 41:294–298
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
J.H. Park and Y.R. Kim contributed equally to this article
Rights and permissions
About this article
Cite this article
Park, J.H., Kim, Y.R., Kim, S.H. et al. Admission B-type natriuretic peptide levels are associated with in-hospital cardiac events in patients with intracranial hemorrhage. Acta Neurochir 157, 21–27 (2015). https://doi.org/10.1007/s00701-014-2260-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-014-2260-0