title: Impact of aneurysm location on cardiopulmonary dysfunction after subarachnoid hemorrhage.
abstract: BACKGROUND
  Cardiopulmonary dysfunction may occur after aneurysmal subarachnoid hemorrhage (SAH), but its characteristics have not been fully clarified. We investigated the impact of aneurysm location on systemic hemodynamics after SAH.
  
  
  METHODS
  This multicenter prospective cohort study measured hemodynamic parameters in relation to aneurysm location in patients with SAH using a single-indicator transpulmonary thermodilution system (PiCCO) on days 1-14.
  
  
  RESULTS
  Of 204 subjects enrolled, 58 had aneurysms of the anterior communicating artery (ACA), 61 of the middle cerebral artery (MCA), 57 of the internal carotid artery (ICA), and 28 of the vertebrobasilar artery (VA/BA). Patient characteristics were similar except for predominance of coiling in the VA/BA. Patients with ACA aneurysm had a lower systemic vascular resistance index (SVRI) in the acute phase and afterload mismatch (lower cardiac index [CI] and higher SVRI) in the spasm phase. Those with ICA aneurysm had a lower CI in the acute phase, and those with VA/BA aneurysm had a warm shock-like condition (higher CI and lower SVRI) in the spasm phase. Patients with MCA aneurysm showed no specific characteristics in CI and SVRI with a significant improvement in B-type natriuretic peptide. Extravascular lung water index was high independent of left cardiac dysfunction. In multivariate analysis, age and ACA were independently related to poor global ejection fraction after SAH.
  
  
  CONCLUSIONS
  Aneurysm location affects cardiac output, vascular resistance, and pulmonary edema in biphasic fashion. Patient age and location of aneurysm in the ACA may be risk factors for cardiac failure after SAH.
authors: Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan. Electronic address: nobstanford@gmail.com.
authors: Nobutaka
authors: N
authors: Horie
authors: Emergency and Critical Care Center, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors: Eiji
authors: E
authors: Isotani
authors: Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
authors: Sumihisa
authors: S
authors: Honda
authors: Department of Neurosurgery, Kansai Medical University, Osaka, Japan.
authors: Hideyuki
authors: H
authors: Oshige
authors: Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan.
authors: Izumi
authors: I
authors: Nagata
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000503:physiopathology; D002302:Cardiac Output; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D019635:Neurosurgical Procedures; D019990:Perioperative Care; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000473:pathology; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology* / Q000601:surgery
keywords: Subarachnoid hemorrhage; aneurysm location; cardiopulmonary dysfunction; systemic hemodynamics