Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2015 | Research

Elevated high-sensitive troponin T on admission is an indicator of poor long-term outcome in patients with subarachnoid haemorrhage: a prospective observational study

Authors: Jonatan Oras, Christina Grivans, Andreas Bartley, Bertil Rydenhag, Sven-Erik Ricksten, Helene Seeman-Lodding

Published in: Critical Care | Issue 1/2016

Login to get access

Abstract

Background

Patients with subarachnoid haemorrhage (SAH) frequently develop cardiac complications in the acute phase after the bleeding. Although a number of studies have shown that increased levels of cardiac biomarkers after SAH are associated with a worse short-term prognosis, no prospective, consecutive study has assessed the association between biomarker release and long-term outcome. We aimed to evaluate whether the cardiac biomarkers, high-sensitive troponin T (hsTnT) and N-terminal pro B-type natriuretic peptide (NTproBNP), were associated with poor 1-year neurological outcome and cerebral infarction due to delayed cerebral ischaemia (CI-DCI).

Methods

In this single-centre prospective observational study, all consecutive patients admitted to our neurointensive care unit from January 2012 to December 2013 with suspected/verified SAH with an onset of symptoms <72 hours were enrolled. Blood samples for hsTnT and NTproBNP were collected during three consecutive days following admission. Patients were followed-up after 1 year using the Glasgow Outcome Scale Extended (GOSE). Poor neurological outcome was defined as GOSE ≤4.

Results

One hundred and seventy seven patients with suspected SAH were admitted during the study period; 143 fulfilled inclusion criteria and 126 fulfilled follow-up. Forty-one patients had poor 1-year outcome and 18 had CI-DCI. Levels of hsTnT and NTproBNP were higher in patients with poor outcome and CI-DCI. In multivariable logistic regression modelling age, poor neurological admission status, cerebral infarction of any cause and peak hsTnT were independently associated with poor late outcome. Both peak hsTnT and peak NTproBNP were independently associated with CI-DCI.

Conclusion

Increased serum levels of the myocardial damage biomarker hsTnT, when measured early after onset of SAH, are independently associated with poor 1-year outcome. Furthermore, release of both hsTnT and NTproBNP are independently associated with CI-DCI. These findings render further support to the notion that troponin release after SAH is an ominous finding. Future studies should evaluate whether there is a causal relationship between early release of biomarkers of myocardial injury after SAH and neurological sequelae.
Literature
1.
Rinkel GJE, Wilde AAM, Vandertop WP, Visser FC, van der Bilt IA, Hasan D, et al. Impact of cardiac complications on outcome after aneurysmal subarachnoid haemorrhage. A meta-analysis Neurology. 2009;72(7):635–42.PubMed
2.
Zaroff JG, Rordorf GA, Newell JB, Ogilvy CS, Levinson JR. Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery. 1999;44(1):34–9. discussion 39–40.PubMedCrossRef
3.
Tung P, Kopelnik A, Banki N, Ong K, Ko N, Lawton MT, et al. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke. 2004;35(2):548–51.PubMedCrossRef
4.
Banki N, Kopelnik A, Tung P, Lawton MT, Gress D, Drew B, et al. Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage. J Neurosurg. 2006;105(1):15–20.PubMedCrossRef
5.
Mayer SA, LiMandri G, Sherman D, Lennihan L, Fink ME, Solomon RA, et al. Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage. J Neurosurg. 1995;83(5):889–96.PubMedCrossRef
6.
Lee VH, Connolly HM, Fulgham JR, Manno EM, Brown JRD, Wijdicks EFM. Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an under appreciated ventricular dysfunction. J Neurosurg. 2006;105(2):264–70.PubMedCrossRef
7.
Naredi S, Lambert G, Eden E, Zall S, Runnerstam M, Rydenhag B, et al. Increased sympathetic nervous activity in patients with nontraumatic subarachnoid hemorrhage. Stroke. 2000;31(4):901–6.PubMedCrossRef
8.
Lee VH, Oh JK, Mulvagh SL, Wijdicks EF. Mechanisms in neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2006;5(3):243–9.PubMedCrossRef
9.
Sugimoto K, Hirose Y, Inamasu J, Kato Y, Yamada Y, Ganaha T, et al. Association between elevated plasma norepinephrine levels and cardiac wall motion abnormality in poor-grade subarachnoid hemorrhage patients. Neurosurg Rev. 2013;36(2):259–66.PubMedCrossRef
10.
Salem R, Vallee F, Depret F, Callebert J, Maurice JP, Marty P, et al. Subarachnoid hemorrhage induces an early and reversible cardiac injury associated with catecholamine release: one-week follow-up study. Crit Care. 2014;18(5):558.PubMedPubMedCentralCrossRef
11.
Prunet B, Basely M, D'Aranda E, Cambefort P, Pons F, Cimarelli S, et al. Impairment of cardiac metabolism and sympathetic innervation after aneurysmal subarachnoid hemorrhage: a nuclear medicine imaging study. Crit Care. 2014;18(3):R131.PubMedPubMedCentralCrossRef
12.
Naidech AM, Kreiter KT, Janjua N, Ostapkovich ND, Parra A, Commichau C, et al. Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation. 2005;112(18):2851–6.PubMedCrossRef
13.
Yarlagadda S, Rajendran P, Miss JC, Banki NM, Kopelnik A, Wu AH, et al. Cardiovascular predictors of in-patient mortality after subarachnoid hemorrhage. Neurocrit Care. 2006;5(2):102–7.PubMedCrossRef
14.
Taub PR, Fields JD, Wu AH, Miss JC, Lawton MT, Smith WS, et al. Elevated BNP is associated with vasospasm-independent cerebral infarction following aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2011;15(1):13–8.PubMedPubMedCentralCrossRef
15.
van der Bilt I, Hasan D, van den Brink R, Cramer MJ, van der Jagt M, van Kooten F, et al. Cardiac dysfunction after aneurysmal subarachnoid hemorrhage: relationship with outcome. Neurology. 2014;82(4):351–8.PubMedCrossRef
16.
Mutoh T, Kazumata K, Terasaka S, Taki Y, Suzuki A, Ishikawa T. Impact of transpulmonary thermodilution-based cardiac contractility and extravascular lung water measurements on clinical outcome of patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage: a retrospective observational study. Crit Care. 2014;18(4):482.PubMedPubMedCentralCrossRef
17.
Temes RE, Badjatia N, Connolly ES, Mayer SA, Parra A, Tessitore E, et al. Left ventricular dysfunction and cerebral infarction from vasospasm after subarachnoid hemorrhage. Neurocrit Care. 2010;13(3):359–65.PubMedCrossRef
18.
Starke RM, Komotar RJ, Otten ML, Schmidt JM, Fernandez LD, Rincon F, et al. Predicting long-term outcome in poor grade aneurysmal subarachnoid haemorrhage patients utilising the Glasgow Coma Scale. J Clin Neurosci. 2009;16(1):26–31.PubMedCrossRef
19.
Mocco J, Ransom ER, Komotar RJ, Sergot PB, Ostapkovich N, Schmidt JM, et al. Long-term domain-specific improvement following poor grade aneurysmal subarachnoid hemorrhage. J Neurol. 2006;253(10):1278–84.PubMedCrossRef
20.
Hop JW, Rinkel GJ, Algra A, van Gijn J. Changes in functional outcome and quality of life in patients and caregivers after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2001;95(6):957–63.PubMedCrossRef
21.
Zaroff JG, Leong J, Kim H, Young WL, Cullen SP, Rao VA, et al. Cardiovascular predictors of long-term outcomes after non-traumatic subarachnoid hemorrhage. Neurocrit Care. 2012;17(3):374–81.PubMedCrossRef
22.
Kent JK, Stephanie L, Ilene S, Inam K, Louise M. Clinical characteristics and outcomes of neurogenic stress cadiomyopathy in aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg. 2013;115(7):909.CrossRef
23.
Crago EA, Kerr ME, Kong Y, Baldisseri M, Horowitz M, Yonas H, et al. The impact of cardiac complications on outcome in the SAH population. Acta Neurol Scand. 2004;110(4):248–53.PubMedCrossRef
24.
Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009;361(9):858–67.PubMedCrossRef
25.
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847.PubMedCrossRef
26.
Shah KB, Nolan MM, Rao K, Wang DJ, Christenson RH, Shanholtz CB, et al. The characteristics and prognostic importance of NT-ProBNP concentrations in critically ill patients. Am J Med. 2007;120(12):1071–7.PubMedCrossRef
27.
Lindner G, Pfortmueller CA, Braun CT, Exadaktylos AK. Non-acute myocardial infarction-related causes of elevated high-sensitive troponin T in the emergency room: a cross-sectional analysis. Intern Emerg Med. 2014;9(3):335–9.PubMedCrossRef
28.
Oras J, Grivans C, Dalla K, Omerovic E, Rydenhag B, Ricksten SE, et al. High-sensitive troponin T and N-terminal pro B-type natriuretic peptide for early detection of stress-induced cardiomyopathy in patients with subarachnoid hemorrhage. Neurocrit Care. 2015;23(2):233–42.PubMedCrossRef
29.
Tung PP, Olmsted E, Kopelnik A, Banki NM, Drew BJ, Ko N, et al. Plasma B-type natriuretic peptide levels are associated with early cardiac dysfunction after subarachnoid hemorrhage. Stroke. 2005;36(7):1567–9.PubMedCrossRef
30.
Parekh N, Venkatesh B, Cross D, Leditschke A, Atherton J, Miles W, et al. Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol. 2000;36(4):1328–35.PubMedCrossRef
31.
Teasdale GM, Pettigrew LEL, Wilson JTL, Murray G, Jennett B. Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow outcome scale. J Neurotrauma. 1998;15(8):587–97.PubMedCrossRef
32.
Wilson JTL, Pettigrew LEL, Teasdale GM. Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: Guidelines for their use. J Neurotrauma. 1998;15(8):573–80.PubMedCrossRef
33.
Diringer MN, Bleck TP. Claude Hemphill 3rd J, Menon D, Shutter L, Vespa P, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society's Multidisciplinary Consensus Conference. Neurocrit Care. 2011;15(2):211–40.PubMedCrossRef
34.
Vergouwen MD, Vermeulen M, van Gijn J, Rinkel GJ, Wijdicks EF, Muizelaar JP, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010;41(10):2391–5.PubMedCrossRef
35.
Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 1988;68(6):985–986.
36.
Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke. 2001;32(9):2012–20.PubMedCrossRef
37.
Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38(8):2315–21.PubMedCrossRef
38.
Jaeger M, Soehle M, Schuhmann MU, Meixensberger J. Clinical significance of impaired cerebrovascular autoregulation after severe aneurysmal subarachnoid hemorrhage. Stroke. 2012;43(8):2097–101.PubMedCrossRef
39.
Cremers CH, van der Bilt IA, van der Schaaf IC, Vergouwen MD, Dankbaar JW, Cramer MJ, et al. Relationship Between Cardiac Dysfunction and Cerebral Perfusion in Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care. 2015. doi;10.​1007/​s12028-015-0188-8
40.
Masuda T, Sato K, Yamamoto S, Matsuyama N, Shimohama T, Matsunaga A, et al. Sympathetic nervous activity and myocardial damage immediately after subarachnoid hemorrhage in a unique animal model. Stroke. 2002;33(6):1671–6.PubMedCrossRef
41.
Grad A, Kiauta T, Osredkar J. Effect of elevated plasma norepinephrine on electrocardiographic changes in subarachnoid hemorrhage. Stroke. 1991;22(6):746–9.PubMedCrossRef
42.
MacKenzie ET, McCulloch J, O'Keane M, Pickard JD, Harper AM. Cerebral circulation and norepinephrine: relevance of the blood brain barrier. Am J Physiol. 1976;231(2):483–8.PubMed
43.
Germano A, d'Avella D, Cicciarello R, Hayes RL, Tomasello F. Blood–brain barrier permeability changes after experimental subarachnoid hemorrhage. Neurosurgery. 1992;30(6):882–6.PubMedCrossRef
44.
McGirt MJ, Blessing R, Nimjee SM, Friedman AH, Alexander MJ, Laskowitz DT, et al. Correlation of serum brain natriuretic peptide with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage. Neurosurgery. 2004;54(6):1369–73.PubMedCrossRef
45.
Sugimoto K, Watanabe E, Yamada A, Iwase M, Sano H, Hishida H, et al. Prognostic implications of left ventricular wall motion abnormalities associated with subarachnoid hemorrhage. Int Heart J. 2008;49(1):75–85.PubMedCrossRef
46.
Schmidt JM, Crimmins M, Lantigua H, Fernandez A, Zammit C, Falo C, et al. Prolonged elevated heart rate is a risk factor for adverse cardiac events and poor outcome after subarachnoid hemorrhage. Neurocrit Care. 2014;20(3):390–8.PubMedPubMedCentralCrossRef
47.
Mocco J, Ransom ER, Komotar RJ, Schmidt JM, Sciacca RR, Mayer SA, et al. Preoperative prediction of long-term outcome in poor-grade aneurysmal subarachnoid hemorrhage. Neurosurgery. 2006;59(3):529–38.PubMedCrossRef
48.
Wilson DA, Nakaji P, Albuquerque FC, McDougall CG, Zabramski JM, Spetzler RF. Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design. J Neurosurg. 2013;119(3):606–12.PubMedCrossRef
49.
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37(3):267–315. doi:10.​1093/​eurheartj/​ehv320.
Metadata
Title
Elevated high-sensitive troponin T on admission is an indicator of poor long-term outcome in patients with subarachnoid haemorrhage: a prospective observational study
Authors
Jonatan Oras
Christina Grivans
Andreas Bartley
Bertil Rydenhag
Sven-Erik Ricksten
Helene Seeman-Lodding
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-1181-5

Other articles of this Issue 1/2016

Critical Care 1/2016 Go to the issue

Research

Reported burden on informal caregivers of ICU survivors: a literature review

Editorial

Understanding the complex host response in sepsis: is diabetes the key?

Research

Moderate hyperoxic versus near-physiological oxygen targets during and after coronary artery bypass surgery: a randomised controlled trial

Review

Management of bleeding in patients treated with direct oral anticoagulants

Research

The predictive value of early acute kidney injury for long-term survival and quality of life of critically ill patients

Research

Effect of hemoadsorption during cardiopulmonary bypass surgery – a blinded, randomized, controlled pilot study using a novel adsorbent