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Impairment of cardiac metabolism and sympathetic innervation after aneurysmal subarachnoid hemorrhage: a nuclear medicine imaging study.

Prunet B, Basely M, D'Aranda E, Cambefort P, Pons F, Cimarelli S, Dagain A, Desse N, Veyrieres JB, Jego C, Lacroix G, Esnault P, Boret H, Goutorbe P, Bussy E, Habib G, Meaudre E - Crit Care (2014)

Bottom Line: Follow-up showed rapid improvement of glucose metabolism in one or two months.Normalization of sympathetic innervation was slower; only 27% of patients (n = 8) exhibited normal (123)I-mIBG scintigraphy after six months.Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Although aneurysmal subarachnoid hemorrhage (SAH) is often complicated by myocardial injury, whether this neurogenic cardiomyopathy is associated with the modification of cardiac metabolism is unknown. This study sought to explore, by positron emission tomography/computed tomography, the presence of altered cardiac glucose metabolism after SAH.

Methods: During a 16-month period, 30 SAH acute phase patients underwent myocardial (18)F- fluorodesoxyglucose positron emission tomography ((18)F-FDGPET), (99m)Tc-tetrofosmin and (123)I-meta-iodobenzylguanidine ((123)I-mIBG) scintigraphy, respectively, assessing glucose metabolism, cardiac perfusion, and sympathetic innervation. Patients with initial abnormalities were followed monthly for two months for (18)F-FDG, and six months later for (123)I-mIBG.

Results: In this SAH population, acute cardiac metabolic disturbance was observed in 83% of patients (n = 25), and sympathetic innervation disturbance affected 90% (n = 27). Myocardial perfusion was normal for all patients. The topography and extent of metabolic defects and innervation abnormalities largely overlapped. Follow-up showed rapid improvement of glucose metabolism in one or two months. Normalization of sympathetic innervation was slower; only 27% of patients (n = 8) exhibited normal (123)I-mIBG scintigraphy after six months. Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes.

Conclusions: These findings support the hypothesis of neurogenic myocardial stunning after SAH. In hemodynamically stable acute phase SAH patients, cardiomyopathy is characterized by diffuse and heterogeneous (18)F-FDG and (123)I-mIBG uptake defect.

Trial registration: Clinicaltrials.gov NCT01218191. Registered 6 October 2010.

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Flow diagram of the study. PET, positron emission tomography; G-SPECT, gated single-photon emission computed tomography.
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Figure 1: Flow diagram of the study. PET, positron emission tomography; G-SPECT, gated single-photon emission computed tomography.

Mentions: During the study period, 40 patients were admitted to our ICU with acute-phase aneurysmal SAH. Five of patients refused to participate and five died before the first isotopic procedure. The remaining 30 patients were enrolled in the study (Figure 1). Patient characteristics, radiological data, and neurosurgical data are summarized in Table 1. No patient had evidence of prior coronary artery disease or diabetes.


Impairment of cardiac metabolism and sympathetic innervation after aneurysmal subarachnoid hemorrhage: a nuclear medicine imaging study.

Prunet B, Basely M, D'Aranda E, Cambefort P, Pons F, Cimarelli S, Dagain A, Desse N, Veyrieres JB, Jego C, Lacroix G, Esnault P, Boret H, Goutorbe P, Bussy E, Habib G, Meaudre E - Crit Care (2014)

Flow diagram of the study. PET, positron emission tomography; G-SPECT, gated single-photon emission computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230019&req=5

Figure 1: Flow diagram of the study. PET, positron emission tomography; G-SPECT, gated single-photon emission computed tomography.
Mentions: During the study period, 40 patients were admitted to our ICU with acute-phase aneurysmal SAH. Five of patients refused to participate and five died before the first isotopic procedure. The remaining 30 patients were enrolled in the study (Figure 1). Patient characteristics, radiological data, and neurosurgical data are summarized in Table 1. No patient had evidence of prior coronary artery disease or diabetes.

Bottom Line: Follow-up showed rapid improvement of glucose metabolism in one or two months.Normalization of sympathetic innervation was slower; only 27% of patients (n = 8) exhibited normal (123)I-mIBG scintigraphy after six months.Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Although aneurysmal subarachnoid hemorrhage (SAH) is often complicated by myocardial injury, whether this neurogenic cardiomyopathy is associated with the modification of cardiac metabolism is unknown. This study sought to explore, by positron emission tomography/computed tomography, the presence of altered cardiac glucose metabolism after SAH.

Methods: During a 16-month period, 30 SAH acute phase patients underwent myocardial (18)F- fluorodesoxyglucose positron emission tomography ((18)F-FDGPET), (99m)Tc-tetrofosmin and (123)I-meta-iodobenzylguanidine ((123)I-mIBG) scintigraphy, respectively, assessing glucose metabolism, cardiac perfusion, and sympathetic innervation. Patients with initial abnormalities were followed monthly for two months for (18)F-FDG, and six months later for (123)I-mIBG.

Results: In this SAH population, acute cardiac metabolic disturbance was observed in 83% of patients (n = 25), and sympathetic innervation disturbance affected 90% (n = 27). Myocardial perfusion was normal for all patients. The topography and extent of metabolic defects and innervation abnormalities largely overlapped. Follow-up showed rapid improvement of glucose metabolism in one or two months. Normalization of sympathetic innervation was slower; only 27% of patients (n = 8) exhibited normal (123)I-mIBG scintigraphy after six months. Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes.

Conclusions: These findings support the hypothesis of neurogenic myocardial stunning after SAH. In hemodynamically stable acute phase SAH patients, cardiomyopathy is characterized by diffuse and heterogeneous (18)F-FDG and (123)I-mIBG uptake defect.

Trial registration: Clinicaltrials.gov NCT01218191. Registered 6 October 2010.

Show MeSH
Related in: MedlinePlus