gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Myocardial injury after aneurysmatic subarachnoidal haemorrhage (aSAH) – Does cisternal blood distribution matters and can elevated cTroponin I within 10 days after ictus indicate cerebral vasospasm in patients with aSAH?

Myokardschädigung nach aneurysmatischer Subarachnoidalblutung (aSAB) – Ist die cisternale Blutverteilung von Bedeutung und kann erhöhtes Troponin I innerhalb der ersten 10 Tage auf cerebrale Vasospasmen bei Patienten mit aSAB hindeuten?

Meeting Abstract

  • presenting/speaker Paiman Shalchian-Tehran - Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Neurochirurgie, Köln, Deutschland
  • Alexander E. Hartmann - Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Neurochirurgie, Köln, Deutschland
  • Andreas Baumann - Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Neurochirurgie, Köln, Deutschland
  • Thorsten Annecke - Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Anästhesiologie und operative Intensivmedizin, Köln, Deutschland
  • Makoto Nakamura - Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Klinik für Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV051

doi: 10.3205/22dgnc058, urn:nbn:de:0183-22dgnc0586

Veröffentlicht: 25. Mai 2022

© 2022 Shalchian-Tehran et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Myocardial injury in patients with aneurysmal subarachnoid hemorrhage (aSAH) is due to intrinsic, excessive secretion of catecholamines by the autonomic nervous system (ANS), which is controlled amongst others by the insula, the anterior cingulate cortex and brainstem. Lesions like infarction or intracranial bleeding (ICH) within these locations can disturb and lead to elevated sympathetic tone with cardiac consequences, which may be detected by cardiac troponin I (cTroponin I). It is well-known that cTroponin I show its peak during the first three days. The course of cTroponin I within the first 10 days after ictus can be affected by ANS and studies about blood distribution within the cranial cisterns and its impact on the ANS are lacking.

Methods: We performed a prospective, monocentric study and subgroup analysis of pts with aSAH with daily measurements of cTroponin I (cut-off <26.2ng/l) for the first 10 days after ictus. Comparison between troponinemia and cisternal blood distribution or coincidental intracerebral hemorrhage (ICH). Pts with history of cardiac diseases, renal insufficiency and sepsis were excluded.

Results: 57 pts were enclosed since 03/2020 at our institution. Troponinemia within the first 10 days after ictus were seen in 37 pts with aSAH (64%). There was a detection of subarachnoid blood within the insular cisterns in 46 pts (80%). Of these, 69% had elevated cTroponin I (n=32 versus n=14 with normal cTroponin I). In pts without insular involvement the interpeduncular cistern seems to be concomitant with elevated cTroponin I, which may be due to close contact to the brainstem (54% vs 45%). Troponinemia is not more involved in patients with concurrent ICH (15 pts aSAH+ICH vs 22 pts. aSAH-ICH). Cerebral vasospasm have been proven in 15 out of 57 pts. Here cTroponin I was elevated in 9 out of 15 pts. (60%) within 72 hours before vasospasm could be detected on digital subtraction angiogram (DSA).

Conclusion: Pts with aSAH and involvement of the insular cistern and the interpeduncular cistern present increased cTroponin I levels. Concomitant ICH in pts with aSAH does not lead to troponinemia more often. Continuous measurements of cTroponin I can indicate cerebral vasospasms in DSA in pts with aSAH within 72 hours.