Evaluation of Cardiac Function in Patients with Supratentorial Tumors and Raised Intracranial Pressure: HABIT-ICP, a Prospective Observational Study Using Transthoracic Echocardiography

Abstract

Objective An acute increase in intracranial pressure (ICP) has been shown to affect cardiac function due to brain ischemia and the associated increased sympathetic activity. However, there is limited literature on the changes in cardiac function in clinical scenarios where there is a gradual and progressive increase in ICP, such as in brain tumors. We aimed to assess and compare the cardiac function in patients with primary supratentorial brain tumors presenting with and without raised ICP for neurosurgery.

Materials and Methods In this prospective observational study, we included 60 patients; Group I (30 patients without features of raised ICP) and Group II (30 patients with features of raised ICP). Transthoracic echocardiography was performed on the day before the surgery and the seventh postoperative day. Hemodynamic, electrocardiographic, and echocardiographic parameters were obtained during pre-, intra-, and postoperative periods and were used for statistical analysis.

Results We found an increased relative wall thickness and an increased incidence of systolic (22%) and diastolic dysfunction (33.3%) in Group II compared with Group I patients. There was an increased incidence of intraoperative adverse events such as postinduction hypotension and vasopressor use in Group II patients. In the postoperative period, there was an improvement in the systolic function; however, the chamber dimensions and diastolic dysfunction did not improve significantly.

Conclusion 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.

Keywords

echocardiography - intracranial pressure - neurosurgery - perioperative - implications - supratentorial brain tumor

Note

The abstract was presented for the Neuroanaesthesia and Critical Care Society Annual Conference on May 12, 2023, at Nottingham, United Kingdom, and was shortlisted for the Harvey Granat Prize.

Authors' Contributions

M.S., A.P.H, N.A, U.P., S.V., and R.P.C.S. approved the final manuscript. All authors contributed to the conception and design of the study, analysis and acquisition of data, interpretation of the results, and were actively involved in drafting the article and revising it critically for important intellectual content.

Ethical Approval

This prospective observational study was approved by the Institutional Ethics Committee (SCT/IEC/2018/1242) prior to the enrollment of the first subject.

Patients' Consent

Written informed consent was obtained from all participating subjects or their legal representative.

Publication History

Article published online:
29 August 2024

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