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Perioperative serum brain natriuretic peptide and cardic troponin in emergency intracranial vascular surgery

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Background: intracranial bleeding is often associated with a large variety of cardiac derangements, ranging from mild regional wall motion abnormalities to frank cardiac insufficiency. There are well known associations between severe SAH and acute ischemic stroke with new occurred cardiac insufficiency. Some authors report cardiac abnormalities in major head trauma with intracranial bleeding. Method: we conducted a prospective study during 2012 with all intracranial bleeding presented to our department and subjected to surgery, but with no prior history of cardiac disease. cTNt and NT-proBNP were measured pre- and post- operatively and we also recorded electrical changes on a 12 lead ECG, and echocardiographic changes (regional wall motion abnormalities and left ventricular ejection fraction).

Results: from 82 patients submitted to emergency surgery for intracranial bleeding, 37 had a cTN I>0.3 ng ml (45%), 57 (69.5%) had a significant increase of >200 pg ml in NT-proBNPover normal values as reported by hardware manufacturer and these levels were incrementally related to SAH severity (Hunt and Hess scale and Fisher scale), to GCS and midline shifts for intracranial hematoma. Numerous patients with increased cardiac troponin had also ECG abnormalities (QT prolongation, various arrhythmias) decrease under 50 % of ejection fraction and ventricular wall motion abnormalities as noted on echocardiography.

Conclusion: Cardiac injury is incrementally worse with increasing intracranial bleeding severity and associated with persistent QTc prolongation and ventricular arrhythmias. Regional wall motion abnormalities and depressed ejection fraction were recorded early in the course of disease and persist to some degree in the majority of those affected.

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