title: The role of norepinephrine and estradiol in the pathogenesis of cardiac wall motion abnormality associated with subarachnoid hemorrhage.
abstract: OBJECTIVE
  The majority of patients with ventricular wall motion abnormality (WMA) associated with subarachnoid hemorrhage (SAH) are postmenopausal women. In addition to elevated catecholamine, the role of estrogen in the pathogenesis of WMA has recently been implicated. The objective of this study is to clarify the interrelation among catecholamine, estrogen, and WMA in patients with SAH.
  
  
  METHODS
  A retrospective analysis was performed on the medical records of 77 patients with SAH (23 men, 54 women) whose plasma levels of epinephrine, norepinephrine, and estradiol had been measured and echocardiograms had been obtained within 48 hours of SAH onset.
  
  
  RESULTS
  Twenty-four patients (31%) were found to sustain WMA on admission. Multivariate regression analysis revealed that decreased estradiol (P=0.018; OR, 0.902) and elevated norepinephrine levels (P=0.027; OR, 1.002) were associated with WMA. After quadrichotomization of 77 patients based on sex/WMA, plasma norepinephrine levels were markedly elevated in men with WMA, whereas estradiol levels were markedly decreased in women with WMA. Plasma norepinephrine and estradiol levels were not correlated. Fifty-four female patients with SAH were further quadrichotomized based on norepinephrine/estradiol levels with a threshold value of 1375 pg/mL for norepinephrine and 11 pg/mL for estradiol. The incidence of WMA in the high-norepinephrine/low-estradiol group was significantly higher than the low-norepinephrine/high-estradiol group.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study to evaluate the interrelation among catecholamine, estrogen, and SAH-induced WMA. Lack of estradiol in postmenopausal women may predispose them to develop WMA after poor-grade SAH. However, the precise role of multiple sex hormones in SAH-induced WMA should be evaluated in future prospective studies.
authors.affiliation: Department of Medical Technology, Fujita Health University School of Health Sciences, 1-98 Kutsukake, Toyoake 470-1192, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hirose
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ito
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwase
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Eiichi
authors.initials: E
authors.lastname: Watanabe
authors.forename: Ayako
authors.initials: A
authors.lastname: Takahashi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004958:Estradiol / Q000097:blood / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009638:Norepinephrine / Q000097:blood / Q000502:physiology*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000000981:diagnostic imaging*; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D004958:Estradiol; D009638:Norepinephrine