Department of Anesthesiology and Critical Care, Bordeaux University Hospital, Place Amélie Raba-Léon, Hôpital Tripode, 33000, Bordeaux, France.
INSERM, BPH, U1219, University of Bordeaux, 33000, Bordeaux, France.
Crit Care. 2023 Nov 21;27(1):455. doi: 10.1186/s13054-023-04738-6.
Cardiac complications due to non-traumatic subarachnoid hemorrhage (SAH) are usually described using classical echocardiographic evaluation. Strain imaging appears to have better sensitivity than standard echocardiographic markers for the diagnosis of left ventricular dysfunction. The aim of this study was to determine the prevalence of cardiac dysfunction defined as a Global Longitudinal Strain (GLS) ≥ - 20% in patients with good-grade SAH (WFNS 1 or 2).
Seventy-six patients with good-grade SAH were prospectively enrolled and analyzed at admission for neurocritical care. Transthoracic echocardiography was performed on days 1, 3, and 7 after hemorrhage. Routine measurements, including left ventricular ejection fraction (LVEF), were performed, and off-line analysis was performed by a blinded examiner, to determine 2-, 3-, and 4-cavity longitudinal strain and left ventricular GLS. GLS was considered altered if it was ≥ - 20%, we also interested the value of ≥ - 17%. LVEF was considered altered if it was < 50%.
On day 1, 60.6% of patients had GLS ≥ - 20% and 21.2% of patient had GLS ≥ - 17%. In comparison, alteration of LVEF was present in only 1.7% of patients. The concordance rate between LVEF < 50% and GLS ≥ - 20% and LVEF ≥ 50% and GLS < - 20% was 46%.
Strain imaging showed a higher prevalence (60.6%) of left ventricular dysfunction during the acute phase of good-grade SAH (WFNS 1 or 2) than previously described.
非创伤性蛛网膜下腔出血（SAH）引起的心脏并发症通常采用经典的超声心动图评估。应变成像似乎比标准超声心动图标志物更能敏感地诊断左心室功能障碍。本研究旨在确定在 WFNS 1 或 2 级的良好分级 SAH 患者中，定义为全局纵向应变（GLS）≥-20%的心脏功能障碍的发生率。
前瞻性纳入 76 例良好分级 SAH 患者，并在神经重症监护病房入院时进行分析。出血后第 1、3 和 7 天行经胸超声心动图检查。进行常规测量，包括左心室射血分数（LVEF），并由盲法检查者进行离线分析，以确定 2、3 和 4 腔室纵向应变和左心室 GLS。如果 GLS≥-20%，则认为 GLS 发生改变，我们也对≥-17%的 GLS 值感兴趣。如果 LVEF<50%，则认为 LVEF 发生改变。
第 1 天，60.6%的患者 GLS≥-20%，21.2%的患者 GLS≥-17%。相比之下，只有 1.7%的患者 LVEF 发生改变。LVEF<50%与 GLS≥-20%和 LVEF≥50%与 GLS<-20%之间的一致性率为 46%。
应变成像显示，在 WFNS 1 或 2 级的良好分级 SAH（急性）期间，左心室功能障碍的发生率（60.6%）高于之前的描述。
