Introduction: Cardiac injury after intracranial hemorrhage is well documented, although most previous studies are retrospective and may be biased by only including patients who had troponins drawn or including those with active cardiovascular disease.
Methods: We retrospectively reviewed the records of 100 consecutive patients with a primary diagnosis of spontaneous intraparenchymal hemorrhage, excluding patients with a history of cardiovascular disease and coagulopathy.
Results: 51% of patients were male with a mean/median age of 70/71 years. Mean/median hematoma volume was 26/15 mL. 79 patients had troponins drawn, with 21/79 (26.6%) >0.10 ng/mL and 8/79 (10.1%) >0.30 ng/mL. Of those patients who obtained an EKG, 35/85 (41.2%) exhibited ischemic changes, 53/85 (62.3%) had rate and/or conduction abnormalities, and 10/85 (11.8%) had a possible MI. Based on transthoracic echocardiography, 8/49 (16.3%) patients exhibited motion abnormalities, 4/49 (8.2%) had an ejection fraction below 50%, and 26/49 (53.1%) showed valvular abnormalities. Mean follow-up was 1 year 5 months, with 3 month and 1 year mortality of 33% and 43% respectively. The in hospital mortality rate was 17%. Statistically significant relationships included echocardiographic motion abnormalities as a predictor of in hospital mortality (p=0.026), ejection fraction below 50% as a predictor of in hospital mortality (p=0.047), presence of subarachnoid hemorrhaging as a predictor of troponin elevations above 0.10ng/mL (p=0.017), and presence of subarachnoid hemorrhaging as a predictor of myocardial infraction read on EKG (p=0.013). Subcortical hemorrhage size showed a trend as a predictor of EKG rate or conduction defects, falling just short of statistical significance (p=0.054).
Conclusions: Spontaneous intraparenchymal hemorrhage is strongly associated with cardiac injury, even in the lowest risk group of patients. A prospective study is warranted to better clarify these relationships.
Patient Care: By better understanding the relationship of intracranial hemorrhage and cardiac injury, we can identify prognositic indicators for high risk patients. This will in turn allow early treatment and vigilance for cardiac complications, with the aim or reducing the resulting morbidity and mortality.
Learning Objectives: 1. Describe what has been published concerning ICH and cardiac injury. 2. Describe the possible shortcomings in our understanding of the prognostic indicators for cardiac injury and related mortality in spontaneous intraparenchymal hemorrhage patients. 3. Describe the relationships we have found concerning this patient population and the value of these relationships with respect to their sensitivity and specificity for identifying patients at high risk for cardiac injury and mortality.
References: Matthew C. Garrett, Ricardo J. Komotar, Robert M. Starke, Darshan Doshi,Marc L. Otten, E. Sander Connolly.Elevated Troponin Levels are Predictive of Mortality in Surgical Intracerebral Hemorrhage Patients. Neurocrit Care (2010) 12:199–203
Maurits D. R. van Bree, Yvo B. W. E. M. Roos,
Ivo A. C. van der Bilt, Arthur A. M. Wilde,
Marieke E. S. Sprengers, Koen de Gans, Mervyn D. I. Vergouwen. Prevalence and Characterization of ECG Abnormalities After Intracerebral Hemorrhage. Neurocrit Care (2010) 12:50–55