Abdelmoneim Sahar S, Wijdicks Eelco F M, Lee Vivien H, Daugherty Wilson P, Bernier Mathieu, Oh Jae K, Pellikka Patricia A, Mulvagh Sharon L
Division of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Neurosurg. 2009 Nov;111(5):1023-8. doi: 10.3171/2009.3.JNS081723.
The pathophysiology of myocardial dysfunction after subarachnoid hemorrhage (SAH) remains unclear. Using myocardial real-time perfusion contrast echocardiography (RTP-CE), the authors evaluated microvascular function in patients with acute SAH.
Over a 15-month period, 10 patients with acute SAH and evidence of cardiac dysfunction were prospectively enrolled. The authors performed RTP-CE within 48 hours of SAH diagnosis. Wall motion and myocardial perfusion were evaluated in 16 left ventricle segments. Qualitative and quantitative RTP-CE analyses were conducted to compare patients with and without regional wall motion abnormalities (RWMAs). Follow-up RTP-CE at a mean of 53.7 +/- 43 days was undertaken in patients with baseline RWMAs.
Ten patients with SAH and evidence of cardiac dysfunction were prospectively enrolled. There were 3 men and 7 women whose mean age was 63.5 +/- 10.1 years. The authors documented evidence of RWMAs in 6 patients. Normal perfusion was demonstrated by RTP-CE in all patients at baseline and follow-up, despite the presence of RWMAs. Compared with patients presenting with normal wall motion, in patients with RWMAs there was a trend for higher quantitative RTP-CE parameters, suggesting hyperemia with mean myocardial blood flow velocity (beta, s(-1)) of 1.08 +/- 0.61 (95% CI 0-2.61) compared with 1.62 +/- 0.64 (95% CI 0.94-2.29) and myocardial blood flow (A x beta, dB/s) of 0.99 +/- 0.41 (95% CI 0-2.0) versus 1.63 +/- 0.86 (95% CI 0.72-2.53). Follow-up RTP-CE was feasible in 3 patients with RWMAs. Regional systolic function was restored in those who completed follow-up.
The authors found that RTP-CE readily evaluates microvascular function in patients with SAH. Wall motion and perfusion dissociation were observed. Quantitative RTP-CE showed a trend for microvascular hyperemia in patients with RWMAs, suggesting that post-SAH myocardial dysfunction could occur in the absence of microvascular dysfunction.
蛛网膜下腔出血（SAH）后心肌功能障碍的病理生理学仍不清楚。作者使用心肌实时灌注对比超声心动图（RTP-CE）评估急性SAH患者的微血管功能。
在15个月的时间里，前瞻性纳入10例急性SAH且有心脏功能障碍证据的患者。作者在SAH诊断后48小时内进行RTP-CE检查。对16个左心室节段的壁运动和心肌灌注进行评估。进行定性和定量RTP-CE分析，以比较有和没有节段性壁运动异常（RWMA）的患者。对基线存在RWMA的患者进行平均53.7±43天的随访RTP-CE检查。
前瞻性纳入10例SAH且有心脏功能障碍证据的患者。其中男性3例，女性7例，平均年龄63.5±10.1岁。作者记录到6例患者存在RWMA证据。尽管存在RWMA，但在基线和随访时，所有患者的RTP-CE均显示灌注正常。与壁运动正常的患者相比，存在RWMA的患者定量RTP-CE参数有升高趋势，提示充血，平均心肌血流速度（β，s-1）为1.08±0.61（95%CI 0 - 2.61），而壁运动正常患者为1.62±0.64（95%CI 0.94 - 2.29）；心肌血流量（A×β，dB/s）分别为0.99±0.41（95%CI 0 - 2.0）和1.63±0.86（95%CI 0.72 - 2.53）。3例存在RWMA的患者可行随访RTP-CE检查。完成随访的患者节段性收缩功能恢复。
作者发现RTP-CE能够轻易评估SAH患者的微血管功能。观察到壁运动与灌注分离现象。定量RTP-CE显示存在RWMA的患者有微血管充血趋势，提示SAH后心肌功能障碍可能在无微血管功能障碍的情况下发生。
