Jong Woo Lee1, Lasya P Sreepada1, Matthew B Bevers1, Karen Li2, Benjamin M Scirica1, Danuzia Santana da Silva1, Galen V Henderson1, Camden Bay1, Alexander P Lin2. 1. From the Department of Neurology (J.W.L., M.B., K.L., G.V.H.), Department of Radiology (L.S., C.B., A.P.L.), and Department of Medicine, Division of Cardiology (B.S., D.S.d.S.), Brigham and Women's Hospital, Boston, MA. 2. From the Department of Neurology (J.W.L., M.B., K.L., G.V.H.), Department of Radiology (L.S., C.B., A.P.L.), and Department of Medicine, Division of Cardiology (B.S., D.S.d.S.), Brigham and Women's Hospital, Boston, MA. aplin@bwh.harvard.edu.
Abstract
BACKGROUND AND OBJECTIVES: To correlate brain metabolites with clinical outcome using magnetic resonance spectroscopy (MRS) in patients undergoing targeted temperature management (TTM) after cardiac arrest and assess their relationships to MRI and EEG variables. METHODS: A prospective cohort of 50 patients was studied. The primary outcome was coma recovery to follow commands. Comparison of MRS measures in the posterior cingulate gyrus, parietal white matter, basal ganglia, and brainstem were also made to 25 normative controls. RESULTS: Fourteen of 50 patients achieved coma recovery before hospital discharge. There was a significant decrease in total N-acetylaspartate (NAA/Cr) and an increase in lactate/creatine (Lac/Cr) in patients who did not recover, with changes most prominent in the posterior cingulate gyrus. Patients who recovered had decrease in NAA/Cr as compared to controls. NAA/Cr had a strong monotonic relationship with MRI cortical apparent diffusion coefficient (ADC); Lac level exponentially increased with decreasing ADC. EEG suppression/burst suppression was strongly associated with Lac elevation. DISCUSSION: NAA and Lac changes are associated with clinical/MRI/EEG changes consistent with hypoxic-ischemic encephalopathy (HIE) and are most prominent in the posterior cingulate gyrus. NAA/Cr decrease observed in patients with good outcomes suggests mild HIE in patients asymptomatic at hospital discharge. The appearance of cortical Lac represents a deterioration of aerobic energy metabolism and is associated with EEG background suppression, synaptic transmission failure, and severe, potentially irreversible HIE. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in patients undergoing TTM after cardiac arrest, brain MRS-determined decrease in total NAA/Cr and an increase in Lac/Cr are associated with an increased risk of not recovering.
BACKGROUND AND OBJECTIVES: To correlate brain metabolites with clinical outcome using magnetic resonance spectroscopy (MRS) in patients undergoing targeted temperature management (TTM) after cardiac arrest and assess their relationships to MRI and EEG variables. METHODS: A prospective cohort of 50 patients was studied. The primary outcome was coma recovery to follow commands. Comparison of MRS measures in the posterior cingulate gyrus, parietal white matter, basal ganglia, and brainstem were also made to 25 normative controls. RESULTS: Fourteen of 50 patients achieved coma recovery before hospital discharge. There was a significant decrease in total N-acetylaspartate (NAA/Cr) and an increase in lactate/creatine (Lac/Cr) in patients who did not recover, with changes most prominent in the posterior cingulate gyrus. Patients who recovered had decrease in NAA/Cr as compared to controls. NAA/Cr had a strong monotonic relationship with MRI cortical apparent diffusion coefficient (ADC); Lac level exponentially increased with decreasing ADC. EEG suppression/burst suppression was strongly associated with Lac elevation. DISCUSSION: NAA and Lac changes are associated with clinical/MRI/EEG changes consistent with hypoxic-ischemic encephalopathy (HIE) and are most prominent in the posterior cingulate gyrus. NAA/Cr decrease observed in patients with good outcomes suggests mild HIE in patients asymptomatic at hospital discharge. The appearance of cortical Lac represents a deterioration of aerobic energy metabolism and is associated with EEG background suppression, synaptic transmission failure, and severe, potentially irreversible HIE. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in patients undergoing TTM after cardiac arrest, brain MRS-determined decrease in total NAA/Cr and an increase in Lac/Cr are associated with an increased risk of not recovering.
Authors: Benjamin C Rowland; Huijun Liao; Fatah Adan; Laura Mariano; John Irvine; Alexander P Lin Journal: J Neuroimaging Date: 2016-09-07 Impact factor: 2.486
Authors: Catherine V M Steinbusch; Caroline M van Heugten; Sascha M C Rasquin; Jeanine A Verbunt; Véronique R M Moulaert Journal: Resuscitation Date: 2017-08-14 Impact factor: 5.262
Authors: Paul M Szumita; Steven Baroletti; Kathleen Ryan Avery; Anthony F Massaro; Peter C Hou; Carol Daddio Pierce; Galen V Henderson; Peter H Stone; Benjamin M Scirica Journal: Crit Pathw Cardiol Date: 2010-12
Authors: A Lorek; Y Takei; E B Cady; J S Wyatt; J Penrice; A D Edwards; D Peebles; M Wylezinska; H Owen-Reece; V Kirkbride Journal: Pediatr Res Date: 1994-12 Impact factor: 3.756
Authors: Barry J Ruijter; Marleen C Tjepkema-Cloostermans; Selma C Tromp; Walter M van den Bergh; Norbert A Foudraine; Francois H M Kornips; Gea Drost; Erik Scholten; Frank H Bosch; Albertus Beishuizen; Michel J A M van Putten; Jeannette Hofmeijer Journal: Ann Neurol Date: 2019-06-24 Impact factor: 10.422