• Nobutaka Horie, Eiji Isotani, Sumihisa Honda, Hideyuki Oshige, Izumi Nagata, and SAH PiCCO Study Group.
• Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan. Electronic address: nobstanford@gmail.com.
• J Stroke Cerebrovasc Dis. 2014 Aug 1;23(7):1795-804.

BackgroundCardiopulmonary 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.MethodsThis 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.ResultsOf 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.ConclusionsAneurysm 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.Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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