Department of Anesthesiology.
Harborview Injury Prevention and Research Center, Seattle, WA.
J Neurosurg Anesthesiol. 2019 Apr;31(2):199-211. doi: 10.1097/ANA.0000000000000493.
The recommended cardiac workup of patients with spontaneous intracerebral hemorrhage (ICH) includes an electrocardiogram (ECG) and cardiac troponin. However, abnormalities in other cardiovascular domains may occur. We reviewed the literature to examine the spectrum of observed cardiovascular abnormalities in patients with ICH.
A narrative review of cardiovascular abnormalities in ECG, cardiac biomarkers, echocardiogram, and hemodynamic domains was conducted on patients with ICH.
We searched PubMed for articles using MeSH Terms "heart," "cardiac," hypertension," "hypotension," "blood pressure," "electro," "echocardio," "troponin," "beta natriuretic peptide," "adverse events," "arrhythmi," "donor," "ICH," "intracerebral hemorrhage." Using Covidence software, 670 articles were screened for title and abstracts, 482 articles for full-text review, and 310 extracted. A total of 161 articles met inclusion and exclusion criteria, and, included in the manuscript. Cardiovascular abnormalities reported after ICH include electrocardiographic abnormalities (56% to 81%) in form of prolonged QT interval (19% to 67%), and ST-T changes (19% to 41%), elevation in cardiac troponin (>0.04 ng/mL), and beta-natriuretic peptide (BNP) (>156.6 pg/mL, up to 78%), echocardiographic abnormalities in form of regional wall motion abnormalities (14%) and reduced ejection fraction. Location and volume of ICH affect the prevalence of cardiovascular abnormalities. Prolonged QT interval, elevated troponin-I, and BNP associated with increased in-hospital mortality after ICH. Blood pressure control after ICH aims to preserve cerebral perfusion pressure and maintain systolic blood pressure between 140 and 179 mm Hg, and avoid intensive blood pressure reduction (110 to 140 mm Hg). The recipients of ICH donor hearts especially those with reduced ejection fraction experience increased early mortality and graft rejection.
Various cardiovascular abnormalities are common after spontaneous ICH. The workup of patients with spontaneous ICH should involve 12-lead ECG, cardiac troponin-I, as well as BNP, and echocardiogram to evaluate for heart failure. Blood pressure control with preservation of cerebral perfusion pressure is a cornerstone of hemodynamic management after ICH. The perioperative implications of hemodynamic perturbations after ICH warrant urgent further examination.
自发性脑出血（ICH）患者的心脏检查包括心电图（ECG）和心脏肌钙蛋白。然而，其他心血管领域可能存在异常。我们查阅了文献，以检查 ICH 患者中观察到的心血管异常谱。
对 ECG、心脏标志物、超声心动图和血流动力学领域的 ICH 患者的心血管异常进行了叙述性综述。
我们在 PubMed 中使用 MeSH 术语“心脏”、“心脏”、“高血压”、“低血压”、“血压”、“心电图”、“超声心动图”、“肌钙蛋白”、“β型利钠肽”、“不良事件”、“心律失常”、“供体”、“ICH”、“脑出血”进行了文章搜索。使用 Covidence 软件，对标题和摘要进行了 670 篇文章的筛选，对全文进行了 482 篇文章的审查，并提取了 310 篇文章。共有 161 篇文章符合纳入和排除标准，并包含在本文中。ICH 后报告的心血管异常包括心电图异常（56%至 81%），表现为 QT 间期延长（19%至 67%）和 ST-T 改变（19%至 41%）、心脏肌钙蛋白升高（>0.04ng/ml）和β型利钠肽（BNP）升高（>156.6pg/ml，高达 78%）、超声心动图异常，表现为局部壁运动异常（14%）和射血分数降低。ICH 的位置和体积影响心血管异常的发生率。ICH 后 QT 间期延长、肌钙蛋白-I 升高和 BNP 与住院死亡率增加相关。ICH 后血压控制旨在维持脑灌注压，维持收缩压在 140 至 179mmHg 之间，并避免强化降压（110 至 140mmHg）。ICH 供体心脏的受者，特别是射血分数降低的受者，早期死亡率和移植物排斥增加。
自发性 ICH 后常出现各种心血管异常。自发性 ICH 患者的检查应包括 12 导联心电图、心脏肌钙蛋白-I 以及 BNP 和超声心动图，以评估心力衰竭。保持脑灌注压的血压控制是 ICH 后血流动力学管理的基石。ICH 后血流动力学紊乱的围手术期意义需要紧急进一步检查。
