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Delayed perihematomal hypoperfusion is associated with poor outcome in intracerebral haemorrhage.
Morotti, Andrea; Busto, Giorgio; Boulouis, Gregoire; Scola, Elisa; Bernardoni, Andrea; Fiorenza, Alessandro; Amadori, Tommaso; Carbone, Federico; Casetta, Ilaria; Montecucco, Fabrizio; Fainardi, Enrico.
Afiliación
  • Morotti A; Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy.
  • Busto G; Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
  • Boulouis G; Department of Neuroradiology, University Hospital of Tours, Centre Val de Loire Region, France.
  • Scola E; Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
  • Bernardoni A; Neuroradiology Unit, Department of Radiology, Arcispedale S. Anna, Ferrara, Italy.
  • Fiorenza A; Radiodiagnostic Unit n. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
  • Amadori T; Radiodiagnostic Unit n. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
  • Carbone F; First Clinic of internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.
  • Casetta I; IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa, Italy.
  • Montecucco F; Section of Neurology, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
  • Fainardi E; First Clinic of internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.
Eur J Clin Invest ; 52(4): e13696, 2022 Apr.
Article en En | MEDLINE | ID: mdl-34706061
BACKGROUND: The aim of this study was to characterize the temporal evolution and prognostic significance of perihematomal perfusion in acute intracerebral haemorrhage (ICH). METHODS: A single-centre prospective cohort of patients with primary spontaneous ICH receives computed tomography perfusion (CTP) within 6 h from onset (T0) and at 7 days (T7). Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the manually outlined perihematomal low-density area. Poor functional prognosis (modified Rankin Scale 3-6) at 90 days was the outcome of interest, and predictors were explored with multivariable logistic regression. RESULTS: A total of 150 patients were studied, of whom 52 (34.7%) had a mRS 3-6 at 90 days. Perihematomal perfusion decreased from T0 to T7 in all patients, but the magnitude of CBF and CBV reduction was larger in patients with unfavourable outcome (median CBF change -7.8 vs. -6.0 ml/100 g/min, p < .001, and median CBV change -0.5 vs. -0.4 ml/100 g, p = .010, respectively). This finding remained significant after adjustment for confounders (odds ratio [OR] for 1 ml/100 g/min CBF reduction: 1.33, 95% confidence interval [CI] (1.15-1.55), p < .001; OR for 0.1 ml/100 g CBV reduction: 1.67, 95% CI 1.18-2.35, p = .004). The presence of CBF < 20 ml/100 g/min at T7 was then demonstrated as an independent predictor of poor functional outcome (adjusted OR: 2.45, 95% CI 1.08-5-54, p = .032). CONCLUSION: Perihaemorrhagic hypoperfusion becomes more severe in the days following acute ICH and is independently associated with poorer outcome. Understanding the underlying biological mechanisms responsible for delayed decrease in perihematomal perfusion is a necessary step towards outcome improvement in patients with ICH.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemorragia Cerebral / Circulación Cerebrovascular Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Clin Invest Año: 2022 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Hemorragia Cerebral / Circulación Cerebrovascular Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Eur J Clin Invest Año: 2022 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Reino Unido