High-Sensitive Troponin T and N-Terminal Pro B-Type Natriuretic Peptide for Early Detection of Stress-Induced Cardiomyopathy in Patients with Subarachnoid Hemorrhage

• Published in: Neurocritical care 2015-10, Vol.23 (2), p.233-242
• Main Authors: Oras, J., Grivans, C., Dalla, K., Omerovic, E., Rydenhag, B., Ricksten, S.-E., Seeman-Lodding, H.
• Format: Article
• Language: English
• Subjects: Aged; Akinesia; Anemia; Aneurysms; Biomarkers; Biomarkers - blood; Blood pressure; Cardiac and Cardiovascular Systems; Cardiac dysfunction; Cardiac function; Cardiomyopathy; Critical Care Medicine; Dyskinesia; Early Diagnosis; Edema; Female; Heart failure; Heart rate; Hemorrhage; High-sensitive troponin T; Humans; Intensive; Internal Medicine; Ischemia; Kardiologi; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; N-terminal pro B-type natriuretic peptide; Natriuretic Peptide, Brain - blood; Neurology; Original Article; Patients; Peptide Fragments - blood; Peptides; Sensitivity and Specificity; Sepsis; Stress induced cardiomyopathy; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - blood; Tako-tsubo; Takotsubo Cardiomyopathy - blood; Troponin T - blood
• ISSN: 1541-6933; 1556-0961; 1556-0961
• DOI: 10.1007/s12028-015-0108-y

Background Patients developing stress-induced cardiomyopathy (SIC) after subarachnoid hemorrhage (SAH) have increased risk of vasospasm, delayed cerebral ischemia and death. We evaluated whether high-sensitive troponin T (hsTnT) and N-terminal pro B-type natriuretic peptide (NTproBNP) are useful biomarkers for early detection of SIC after SAH. Methods Medical records of all patients admitted to our NICU with suspected or verified SAH from January 2010 to August 2014 were reviewed. Patients in whom echocardiography was performed and blood samples for measurements of hsTnT and/or NTproBNP were obtained, within 72 and 48 h, respectively, after onset of symptoms, were included. SIC was defined as reversible left ventricular segmental hypokinesia diagnosed by echocardiography. Results A total of 502 SAH patients were admitted during the study period, 112 patients fulfilled inclusion criteria and 25 patients fulfilled SIC criteria. Peak levels of hsTnT and NTproBNP were higher in patients with SIC ( p   89 ng/l or a NTproBNP > 2,615 ng/l obtained within 48 h after onset of symptoms had a sensitivity of 100 % and a specificity of 79 % in detecting SIC. Conclusions The cardiac biomarkers, hsTnT and NTproBNP, are increased early after SAH and levels are considerably higher in patients with SIC. These biomarkers are useful for screening of SIC, which could make earlier diagnosis and treatment of SIC in SAH patients possible.