Left Ventricular Asynergy Induced by Elevated Activity of Noradrenergic Nervous System : A Study of 717 Patients in Acute Phase of Subarachnoid Hemorrhage

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Recently it has been documented that myocardial damage with left ventricular asynergy (LV ASYN) develops after onset of subarachnoid hemorrhage (SAH). Furthermore, LV ASYN is suggested to result from myocardial damage induced by catecholamines. However, it is still unknown whether the noradrenergic nervous activity participates in the appearance of LV ASYN following SAH. In a prospective study, 717 patients with SAH received a two-dimentional echocardiogram on admission. LV ASYN was assessed using wall motion score (TWMS; sum of the score in 11 segments, 1=normokinesis to 4=dyskinesis). Sixty nine patients had LV ASYN (ASYN(+) group; 58±12 years) and were compared to the remaining 648 patients without LV ASYN (ASYN(-); 56±13 years). Plasma concentrations of noradrenaline (NA), adrenaline (ADR) and 3-methoxy-4-hydoroxy-phenylethyleneglycol (MHPG), and serum levels of CK-MB (MB), myosin light chain (Mn), troponin-T (Tn) and hANP were measured. Serial hemodynamic changes were evaluated by Swan-Ganz catheter and echocardiogram in 25 patients with LV ASYN. Plasma concentrations of NA, ADR and MHPG on admission were significantly higher in ASYN(+) group than in ASYN(-) group (p<0.001, p<0.001 and p<0.001, respectively). Peak levels of MB, Mn, Tn and hANP elevated significantly in ASYN(+) group, compared with those in ASYN(-) group (p<0.001, p<0.001, p<0.001, and p<0.001, respectively). In ASYN(+) group, echocardiography revealed diffuse segmental wall motion abnormalities and reduced LV ejection fraction (EF) in the acute phase of SAH, which improved within 1 to 15 days (mean duration; 6.3±5.1 days). Pulmonary arterial pressure and pulmonary capillary wedge pressure increased on admission and lowered significantly to normal ranges after improvement of LV ASYN (p<0.01, p<0.001, and p<0.001, respectively). Cardiac index (1/min/m^2) and LVEF(%) also improved significantly from 2.5±0.7 and 36.7±13.4 on admission to 4.4±0.8 (p<0.001) and 64.8±8.5 (p<0.001) after the improvement, respectively. TWMS correlated positively to NA, MHPG, MB, Mn and Tn (r=0.60, r=0.52, r=0.49, r=0.61 and r=0.65, respectively). There were also significant positive correlations between MB and NA (r=0.54), Mn and NA (r=0.62), Mn and MHPG (r=0.58), Tn and NA (r=0.87), and Tn and ADR (r=0.50). These observations indicated that elevated activity of the noradrenergic nervous system following the onset of SAH affected the occurrence of LV ASYN and myocardial damage with necrosis and resulted in a transient LV dysfunction.
北里大学の論文
1998-12-31

Left Ventricular Asynergy Induced by Elevated Activity of Noradrenergic Nervous System : A Study of 717 Patients in Acute Phase of Subarachnoid Hemorrhage

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