Comparison of Hemodynamics and Cardiac Function before and after Neurosurgery in Patients with and without Raised Intracranial Pressure: A Pilot Observational Study with Transthoracic Echocardiography

Background: Raised intracranial pressure (ICP) can have profound cardiovascular effects which can adversely affect the prognosis of neurosurgical patients. Intracranial hypertension in brain death is associated with cardiac dysfunction; when such a heart is transplanted, cardiac dysfunction often resolves. This scenario offers insight into the mechanisms of reversible forms of cardiac injury and suggests that treatment of the extracardiac milieu can result in the recovery of cardiac function. Thus, we hypothesized that if the milieu of raised ICP is removed by neurosurgical procedures, the cardiac dysfunction in such conditions may resolve. The objective was to evaluate our hypothesis whether normalization of ICP after neurosurgery will revert the effects of intracranial hypertension on hemodynamics and cardiac mechanical function.

Materials and Methods: This pilot prospective observational study included 50 patients; 25 patients with raised intracranial pressure (ICP) and 25 patients without raised ICP for whom transthoracic echocardiography was performed before and after neurosurgery. Hemodynamic and echocardiographic parameters were collected during pre-, intra-, and postoperative periods and used for statistical analysis.

Results: An increased incidence of markers of diastolic dysfunction (40%) and systolic dysfunction (20%), which was statistically significant (p < 0.001) was found in the raised ICP group. Though markers of systolic dysfunction improved, diastolic dysfunction did not revert with neurosurgery.

Conclusions: Our study suggests that raised ICP might contribute to the pathophysiology of sympathetic overactivity and sympathetically driven cardiac dysfunction, which does not entirely revert in the immediate postoperative period.

Publikationsverlauf

Artikel online veröffentlicht:
25. März 2020