Clinical significance of elevated natriuretic peptide levels and cardiopulmonary parameters after subarachnoid hemorrhage.
Daily changes in serum concentrations of natriuretic peptides and various cardiopulmonary parameters were measured after the onset of subarachnoid hemorrhage (SAH) to investigate the pathogenesis of the cardiac and pulmonary consequences in 15 patients with acute phase SAH, divided into the control group (n = 5) with consciousness continuously preserved from SAH onset to admission, and the consciousness disturbance group (n = 10). Daily changes in serum A-type and B-type natriuretic peptides (ANP and BNP, respectively) were measured for 10 days, and intrathoracic blood volume index and extravascular lung water index (EVLWI) were measured for 5 days by the single transpulmonary thermodilution method. Natriuretic peptides in the consciousness disturbance group showed significantly higher values during the 10-day period, with ANP 119.2 +/- 12.4 pg/ml (mean +/- standard error of the mean, p = 0.005) on day 2 and BNP 354.1 +/- 80.3 pg/ml (p = 0.009) on day 1. EVLWI showed higher values in the consciousness disturbance group compared to the control group throughout the 5-day period. The increases in natriuretic peptide levels and increase in pulmonary extravascular water content found in SAH patients with consciousness disturbance show that load on the left ventricle or atrium as well as pulmonary capillary pressure are increased immediately after onset, supporting the contention that excessive release of catecholamines occurs at this time.
Nakamura
Tatsuya
T
Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara.
Okuchi
Kazuo
K
Matsuyama
Takeshi
T
Fukushima
Hidetada
H
Seki
Tadahiko
T
Konobu
Toshifumi
T
Nishio
Kenji
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D001810:Blood Volume; D002395:Catecholamines / Q000378:metabolism; D015633:Extravascular Lung Water; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011654:Pulmonary Edema / Q000097:blood / Q000209:etiology; D012964:Sodium / Q000097:blood; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000150:complications / Q000523:psychology; D013815:Thermodilution; D014474:Unconsciousness / Q000097:blood* / Q000209:etiology
D002395:Catecholamines; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor; D012964:Sodium