B-type natriuretic peptide release and left ventricular filling pressure assessed by echocardiographic study after subarachnoid haemorrhage: a prospective study in non-cardiac patients.
Crit Care. 2009 May 20;13(3):R76
Authors: Meaudre E, Jego C, Kenane N, Montcriol A, Boret H, Goutorbe P, Habib G, Palmier B
ABSTRACT: INTRODUCTION: Serum B-type natriuretic peptide (BNP) is frequently elevated after subarachnoid hemorrhage (SAH), but whether this high BNP level is related to transient elevation of left ventricular filling pressure (LVFP) is unknown. However, in patients with pre-existent cardiac pathologies, it is impossible to differentiate between BNP elevation caused by chronic cardiac abnormalities and BNP related to acute neurocardiac injury. METHODS: All adult patients with SAH admitted to our intensive care unit were eligible. Patients were excluded for the following reasons: admission >48 h after aneurysm rupture, pre-existing hypertension, or cardiac disease. Levels of BNP and cardiac troponin I were measured daily for 7 days. Echocardiography was performed by a blinded cardiologist on days 1, 2, and 7. Doppler signals from the mitral inflow, tissue Doppler, and the color M-mode-derived flow propagation velocity (FPV) were obtained to assess echo-estimated LVFP. RESULTS: During a 3-yr period, sixty-six consecutive patients with SAH were admitted. Thirty one patients were studied. The BNP level was >100 ng/L in 25 patients (80%) during the first 3 days, with a peak on day 2 (median, 126 ng/L) followed by a gradual decrease (median variation days 1-7, 70%). All patients had an ejection fraction >50%. Early transmitral velocity/tissue Doppler mitral annular early diastolic velocity was low: 5.4 (+/-1.5) on day 1, 5.8 (+/-1.2) on day 2, and 5.1 (+/-0.9) on day 7. Early transmitral velocity/ (FPV) was also low: 1.27 (+/-0.4), 1.25 (+/-0.3), and 1.1 (+/-0.2) on days 1, 2, and 7, respectively. Cardiac troponin I levels ranged 0-3.67 microg/L and were correlated with BNP (r=0.63, P<0.01). CONCLUSIONS: BNP rises gradually over two days and returns to normal within a week after SAH. Its release is associated with myocardial necrosis, but is unrelated to elevated LVFP assessed by echocardiography.
PMID: 19454040 [PubMed - as supplied by publisher]