Plasma B-type natriuretic peptide levels are associated with early cardiac dysfunction after subarachnoid hemorrhage.
OBJECTIVE
Serum B-type natriuretic peptide (BNP) is elevated after subarachnoid hemorrhage (SAH), as well as in the setting of congestive heart failure and myocardial infarction. The aim of this study was to prospectively quantify the relationship between BNP levels and cardiac outcomes after SAH.


METHODS
Plasma was collected for BNP measurements as soon as possible after enrollment; a mean of 5+/-4 days after SAH symptom onset. On days 1, 3, and 6 after enrollment, troponin I (cTi) was measured and 2-dimensional echocardiography was performed. The following cardiac variables were collected and treated dichotomously: left ventricular ejection fraction (LVEF), regional wall motion abnormalities (RWMA), diastolic dysfunction, pulmonary edema, and cTi.


RESULTS
There were 57 subjects. The median BNP level was 141 pg/mL (range, 0.8 to 3330 pg/mL). Higher mean BNP levels were present in those with RWMA (550 versus 261 pg/mL; P=0.012), diastolic dysfunction (360 versus 44; P=0.011), pulmonary edema (719 versus 204; P=0.016), elevated cTi (662 versus 240; P=0.004), and LVEF <50% (644 versus 281; P=0.015).


CONCLUSIONS
Early after SAH, elevated BNP levels are associated with myocardial necrosis, pulmonary edema, and both systolic and diastolic dysfunction of the left ventricle. These findings support the hypothesis that the heart releases BNP into the systemic circulation early after SAH.
Tung
Poyee P
PP
Division of Cardiology, University of California, San Francisco, CA, USA.
Olmsted
Elise
E
Kopelnik
Alexander
A
Banki
Nader M
NM
Drew
Barbara J
BJ
Ko
Nerissa
N
Lawton
Michael T
MT
Smith
Wade
W
Foster
Elyse
E
Young
William L
WL
Zaroff
Jonathan G
JG
D000368:Aged; D015331:Cohort Studies; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000473:pathology; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000473:pathology; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000096:biosynthesis; D018487:Ventricular Dysfunction, Left / Q000097:blood*; D016277:Ventricular Function, Left
D019210:Troponin I; D020097:Natriuretic Peptide, Brain