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The relationship between BNP, neurocardiac injury severity, noninvasive cardiac output, and outcomes after aneurysmal subarachnoid hemorrhage

McAteer, Amber (2016) The relationship between BNP, neurocardiac injury severity, noninvasive cardiac output, and outcomes after aneurysmal subarachnoid hemorrhage. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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BACKGROUND: Neurocardiac injury is a type of myocardial dysfunction associated with neurological insult to the brain and occurs in 31-48% of aneurysmal subarachnoid hemorrhage (aSAH) patients. Elevated cardiac troponin I (cTnI) is commonly used to diagnose neurocardiac injury and has been associated with poor outcomes after aSAH. Brain natriuretic peptide (BNP) is another marker of cardiac dysfunction, but is more often used to evaluate varying degrees of heart failure. The purpose of this study was to examine the relationship between BNP and a) neurocardiac injury severity as defined by cTnI level, b) noninvasive continuous cardiac output (NCCO) monitoring parameters, and c) outcomes in aSAH patients.

METHODS: This descriptive longitudinal study enrolled 30 adult patients age < 75 years diagnosed with aSAH. Data collected for 14 days included BNP and cTnI levels, NCCO monitoring parameters, and outcomes (modified Rankin scale [mRS] and mortality) at hospital discharge and three months. Generalized estimating equations (GEE) were used to evaluate the longitudinal association between BNP and cTnI, BNP and NCCO parameters within 30 minutes of BNP determination, and BNP and outcomes. BNP and NCCO variables required log transformation due to non-normal distribution.

RESULTS: Elevated BNP was significantly associated with cTnI. For every 1 unit increase in log BNP, cTnI increased by 0.05 ng/ml (p = .001). BNP was also significantly associated with thoracic fluid content (p = .0003) but no other NCCO parameters. On multivariable analyses, significant associations were found between BNP and poor mRS. For every 1 unit log BNP, patients were 3.16 times more likely to have a poor mRS at discharge (p = .021) and 5.40 times more likely to have poor mRS at 3 months (p < .0001).

CONCLUSIONS: There is a significant relationship between BNP, cTnI, and poor outcomes after aSAH. BNP may have utility as a marker of neurocardiac injury and outcomes after aSAH.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
McAteer, Amberalm260@pitt.eduALM260
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorHravnak,
Committee MemberYousef,
Committee MemberCrago,
Committee MemberChang,
Committee MemberGallek,
Date: 25 April 2016
Date Type: Publication
Defense Date: 11 April 2016
Approval Date: 25 April 2016
Submission Date: 13 April 2016
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 27
Institution: University of Pittsburgh
Schools and Programs: David C. Frederick Honors College
School of Nursing > Nursing
Degree: BSN - Bachelor of Science in Nursing
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: aneurysmal subarachnoid hemorrhage, BNP, cTnI, neurocardiac injury, noninvasive cardiac output
Additional Information: NIH NINR R01NR004339​
Date Deposited: 25 Apr 2016 16:26
Last Modified: 15 Nov 2016 14:32


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