2.50
Hdl Handle:
http://hdl.handle.net/10755/157139
Category:
Abstract
Type:
Presentation
Title:
Impact of Myocardial Injury in Patients after Subarachnoid Hemorrhage
Author(s):
Miketic, Joyce; Hravnak, Marilyn; Crago, Elizabeth
Author Details:
Joyce Miketic, University of Pittsburgh, Pittsburgh, Pennsylvania, USA, email: jkm10+@pitt.edu; Marilyn Hravnak; Elizabeth Crago
Abstract:
PURPOSE: The objective of this study is to describe the prevalence of myocardial injury as quantified by elevated cardiac troponin I (cTnI) at > 0.3ng/ml within the first 5 days after aneurysmal Subarachnoid hemorrhage (aSAH) and its impact upon functional outcomes and mortality at 3 months. BACKGROUND: Patients with aSAH suffer a primary brain injury at the time of an aneurysm rupture. There is evidence that they may also experience myocardial injury at the time of rupture due to a hypothesized catecholamine surge, but the prevalence of this problem and its impact upon patient outcomes has not been well described. METHODS: This prospective longitudinal study recruited 237 aSAH patients ages 24-82 (M=54.5; SD=11) with a Fisher grade >2 and/or Hunt/Hess grade =3 who were admitted to the Neuro Intensive Care Unit. Serum cTnI was collected for 5 days following enrollment in the study. Patients dichotomized into myocardial injury (cTnI peak =0.3ng/ml) or no injury (cTnI <0.3ng/ml). Outcomes evaluated by interview at 3 months were patients' perception of functional recovery measured by the Glasgow Outcome Scale (GOS) and functional disability by the Modified Rankin Scale (MRS) and family report of death. Descriptive, Chi-square, and Binary Logistic Regression analyses (SPSSv16.0). RESULTS: 43% of subjects had elevated cTnI with few patients in either group having a past medical history for cardiac disease (15.6% cTnI=0.3ng/ml vs. 10.3% cTnI <0.3ng/ml, p= .247). A significant relationship existed between cTnI=0.3ng/ml and bleed severity by Hunt/Hess, Fisher, and Age. cTnI=0.3ng/ml was significantly related to poor outcomes by both GOS (p=0.000) and MRS (p=0.000). Forty patients died and there was a significant association between cTnI=0.3ng/ml and death (p<0.0001). cTnI=0.3ng/ml remained a significant predictor of poor outcome by MRS (OR=2.7, 95%CI, 1.3-5.9, p=.010) and GOS (OR=2.2, 95%CI, 1.0-4.6, p=.0141) after controlling for bleed severity and race. CONCLUSIONS: Myocardial injury occurs commonly in patients without cardiac history after aSAH, and is associated with both bleed severity and poorer patient outcomes. Myocardial injury is also an independent predictor of poor outcomes even after other contributors such as race, age, and bleed severity are controlled for. Further study will determine the mechanistic link between myocardial injury and poorer aSAH outcomes. Funding NHLBI R01HL074316.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleImpact of Myocardial Injury in Patients after Subarachnoid Hemorrhageen_GB
dc.contributor.authorMiketic, Joyceen_GB
dc.contributor.authorHravnak, Marilynen_GB
dc.contributor.authorCrago, Elizabethen_GB
dc.author.detailsJoyce Miketic, University of Pittsburgh, Pittsburgh, Pennsylvania, USA, email: jkm10+@pitt.edu; Marilyn Hravnak; Elizabeth Cragoen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157139-
dc.description.abstractPURPOSE: The objective of this study is to describe the prevalence of myocardial injury as quantified by elevated cardiac troponin I (cTnI) at > 0.3ng/ml within the first 5 days after aneurysmal Subarachnoid hemorrhage (aSAH) and its impact upon functional outcomes and mortality at 3 months. BACKGROUND: Patients with aSAH suffer a primary brain injury at the time of an aneurysm rupture. There is evidence that they may also experience myocardial injury at the time of rupture due to a hypothesized catecholamine surge, but the prevalence of this problem and its impact upon patient outcomes has not been well described. METHODS: This prospective longitudinal study recruited 237 aSAH patients ages 24-82 (M=54.5; SD=11) with a Fisher grade >2 and/or Hunt/Hess grade =3 who were admitted to the Neuro Intensive Care Unit. Serum cTnI was collected for 5 days following enrollment in the study. Patients dichotomized into myocardial injury (cTnI peak =0.3ng/ml) or no injury (cTnI <0.3ng/ml). Outcomes evaluated by interview at 3 months were patients' perception of functional recovery measured by the Glasgow Outcome Scale (GOS) and functional disability by the Modified Rankin Scale (MRS) and family report of death. Descriptive, Chi-square, and Binary Logistic Regression analyses (SPSSv16.0). RESULTS: 43% of subjects had elevated cTnI with few patients in either group having a past medical history for cardiac disease (15.6% cTnI=0.3ng/ml vs. 10.3% cTnI <0.3ng/ml, p= .247). A significant relationship existed between cTnI=0.3ng/ml and bleed severity by Hunt/Hess, Fisher, and Age. cTnI=0.3ng/ml was significantly related to poor outcomes by both GOS (p=0.000) and MRS (p=0.000). Forty patients died and there was a significant association between cTnI=0.3ng/ml and death (p<0.0001). cTnI=0.3ng/ml remained a significant predictor of poor outcome by MRS (OR=2.7, 95%CI, 1.3-5.9, p=.010) and GOS (OR=2.2, 95%CI, 1.0-4.6, p=.0141) after controlling for bleed severity and race. CONCLUSIONS: Myocardial injury occurs commonly in patients without cardiac history after aSAH, and is associated with both bleed severity and poorer patient outcomes. Myocardial injury is also an independent predictor of poor outcomes even after other contributors such as race, age, and bleed severity are controlled for. Further study will determine the mechanistic link between myocardial injury and poorer aSAH outcomes. Funding NHLBI R01HL074316.en_GB
dc.date.available2011-10-26T19:27:24Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:27:24Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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