title: Lack of evidence for an association between hemodynamic variables and hematoma growth in spontaneous intracerebral hemorrhage.
abstract: OBJECTIVE
  Early hematoma expansion in spontaneous intracerebral hemorrhage (ICH) is associated with worse clinical outcome. We hypothesized that hemodynamic parameters are associated with the increase in hematoma volume owing to their relationship to blood vessel wall stresses.
  
  
  METHODS
  We performed a post hoc analysis of clinical and computed tomography (CT) data from patients enrolled in a prospective observational study of ICH patients presenting within 3 hours from symptom onset. Hematoma volumes were measured at hospital arrival and at 1 and 20 hours from presentation. Blood pressure and heart rate, recorded at 19 time points between presentation and 20 hours, were used to derive hemodynamic variables. Multivariable logistic-regression models were constructed to assess the relation between hemodynamic parameters and hematoma growth, adjusted for clinical covariates.
  
  
  RESULTS
  From the original study, 98 patients underwent baseline and 1-hour CT scans; of these, 65 had 20-hour CT scans. Substantial hematoma growth was observed in 28% within the first hour. Of the 65 patients not undergoing surgery within 20 hours, 37% experienced hematoma growth by 20 hours. Neither baseline or peak hemodynamic parameters nor changes in hemodynamic parameters were significantly associated with hematoma growth at either 1 or 20 hours.
  
  
  CONCLUSIONS
  We found no blood pressure or heart rate parameters, individually or in combination, that were associated with hematoma growth. Our data suggest the influence of hemodynamic parameters on vessel wall stress to be an unlikely target for intervention in reducing the risk of early hematoma growth in ICH.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0769, USA. edward.jauch@uc.edu
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jauch
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.forename: Jane
authors.initials: J
authors.lastname: Khoury
authors.forename: William
authors.initials: W
authors.lastname: Barsan
authors.forename: Joseph
authors.initials: J
authors.lastname: Broderick
authors.forename: Arthur
authors.initials: A
authors.lastname: Pancioli
authors.forename: Thomas
authors.initials: T
authors.lastname: Brott
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed