Study on Correlation between Imaging Changes and Consciousness Disturbance and Cerebrocardiac Syndrome Secondary to Subarachnoid Hemorrhage
HUO Jie, CHEN Biyao, ZHANG Chuji, XU Bin, JI Ruijun
2023, 18(07):
811-816.
DOI: 10.3969/j.issn.1673-5765.2023.07.011
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Objective To explore the relationship and predictive value of imaging changes of subarachnoid hemorrhage, the degree of consciousness disturbance and cerebrocardiac syndrome secondary to subarachnoid hemorrhage.
Methods Patients with subarachnoid hemorrhage aged 18-70 years who were diagnosed and treated in the emergency room of Beijing Tiantan Hospital, Capital Medical University from May 2020 to May 2022 were retrospectively included. Skull CT was performed immediately after admission to evaluate the modified Fisher scale in all cases, and GCS were performed on the day of hemorrhage. Ecg and blood samples were collected for cardiac troponin I (cTNI) and B-type natriuretic peptide (BNP) detection on the 1st, 3rd, 5th, 7th and 14th day after admission, and echocardiography was completed on the 1st and 14th day after admission. Left ventricular ejection fraction (LVEF) was measured. Average values of cTNI, BNP and LVEF were calculated for multiple times as analysis data. When the data of all cases were analyzed, they were divided into cerebrocardiac syndrome group and non-cerebrocardiac syndrome group according to the presence or absence of cerebrocardiac syndrome.
Results A total of 261 patients were included, including 146 (55.9%) in the cerebrocardiac syndrome group and 115 (44.1%) in the non-cerebrocardiac syndrome group. The median cTNI [3.214 (1.125-6.101) ng/mL vs. 0.009(0.005-0.015) ng/mL, P=0.014] and BNP [589.12 (426.19-695.42) pg/mL vs. 78.47 (55.25-102.34) pg/mL, P=0.009] were higher in the group with cerebrocardiac syndrome than in the group with non-cerebrocardiac syndrome. The mean value of LVEF (42.57%±3.52% vs. 53.24%±3.14%, P=0.012), GCS score (9.12±2.26 vs. 12.85±1.58, P=0.038), modified Fisher grade (2.84±0.72 vs. 1.75±0.34, P=0.045) was lower than that of the non-cerebrocardiac syndrome group. GCS score was negatively correlated with mean cTNI (r=-0.458, P<0.001) and mean BNP (r=-0.724, P<0.001), and positively correlated with mean LVEF (r=0.687, P<0.001). The modified Fisher grading was positively correlated with the mean of cTNI (r=0.542, P<0.001) and BNP (r=0.429, P<0.001), and negatively correlated with the mean of LVEF (r=-0.721, P<0.001). The ROC curve of the diagnostic value of the GCS score for the cerebrocardiac syndrome secondary to subarachnoid hemorrhage was 0.813 (95%CI 0.728-0.898), and the optimal cut-off value was 0.628 (at this time, the sensitivity was 68.3%, the specificity was 94.6%). The AUC of the modified Fisher classification was 0.820 (95%CI 0.730-0.910), and the optimal cut-off was 0.542 (sensitivity was 92.1%, specificity was 62.2%).
Conclusions The lower the GCS score of subarachnoid hemorrhage, the higher the probability of secondary cerebrocardiac syndrome. The higher the modified Fisher grade, the greater the likelihood of secondary cerebrocardiac syndrome. The modified Fisher scale and GCS score may predict the cerebrocardiac syndrome timely and accurately.
