Clinical outcomes after neurogenic stress induced cardiomyopathy in aneurysmal sub-arachnoid hemorrhage: a prospective cohort study

Kent J Kilbourn; Gilbert Ching; David I Silverman; Louise McCullough; Robert J Brown

doi:10.1016/j.clineuro.2014.10.017

Clinical outcomes after neurogenic stress induced cardiomyopathy in aneurysmal sub-arachnoid hemorrhage: a prospective cohort study

Clin Neurol Neurosurg. 2015 Jan:128:4-9. doi: 10.1016/j.clineuro.2014.10.017. Epub 2014 Nov 4.

Authors

Kent J Kilbourn¹, Gilbert Ching², David I Silverman², Louise McCullough³, Robert J Brown⁴

Affiliations

¹ Hartford Hospital, Department of Neurosurgery, 80 Seymour Street, Hartford 06102, USA. Electronic address: kent.kilbourn@hhchealth.org.
² Hartford Hospital, Division of Cardiology, 80 Seymour Street, Hartford 06102, USA.
³ University of Connecticut Health Center, Department of Neurology, 263 Farmington Avenue, Farmington 06030, USA.
⁴ Hartford Hospital, Department of Neurosurgery, 80 Seymour Street, Hartford 06102, USA; University of Connecticut Health Center, Department of Neurology, 263 Farmington Avenue, Farmington 06030, USA.

PMID: 25462088
DOI: 10.1016/j.clineuro.2014.10.017

Abstract

Introduction: Neurogenic stress cardiomyopathy (NCM) has been associated with poor outcomes in the setting of aneurysmal subarachnoid hemorrhage (aSAH). Much less is known regarding recovery of cardiac function. The aim of this prospective cohort study was to study the rate of early cardiac recovery after NCM and the potential effect of NCM on short term functional recovery. A secondary aim sought to determine whether certain biomarkers may be associated with the development of NCM.

Methods: Patients with confirmed aSAH between November 2012 and October 2013 were prospectively enrolled and received echocardiograms within 48 h of admission. Ejection fraction (%) and regional wall motion abnormality score index (RWMI) were noted. All patients with confirmed aSAH had a troponin and BNP level drawn on admission. Patients with confirmed NCM received a follow up echocardiogram 7-21 days after the initial echocardiogram. Clinical follow up at 3 months evaluated mortality, mRS and mBI scores.

Results: 63 patients with confirmed aSAH were enrolled. In this cohort 11 (17%) patients were confirmed to have NCM. The NCM group had higher in-hospital mortality [n = 4(36.4%)] compared to the non-NCM group [n = 5(9.6%)] (p = .021). At 3 months the development of NCM was associated with an unfavorable mRS (p = 0.042) and mBI (p = 0.005). Both an elevated BNP (> 100 pg/mL) and elevated troponin (>0.3 mg/dL) were associated with the development of NCM. Follow-up echocardiograms were performed within 21 days of admission on 8 patients with NCM. An abnormal RWMI of 1.5 or higher was present in 5(71%) patients.

Conclusion: NCM is a frequent complication associated with aSAH. The onset of the disease occurs early in the course of aSAH and an elevated BNP and troponin may be associated with the onset of NCM. Cardiac function often remains impaired during the acute recovery phase potentially impeding resuscitation during this period. The routine use of short term follow-up echocardiography may be recommended.

Keywords: Aneurysmal subarachnoid hemorrhage; Echocardiography; Neurogenic stress cardiomyopathy; Tako-tsubo.

MeSH terms

Adult
Aged
Aged, 80 and over
Electrocardiography
Female
Follow-Up Studies
Humans
Male
Middle Aged
Natriuretic Peptide, Brain / blood
Recovery of Function / physiology*
Subarachnoid Hemorrhage / complications*
Takotsubo Cardiomyopathy / etiology*
Takotsubo Cardiomyopathy / physiopathology
Troponin / blood

Substances

Troponin
Natriuretic Peptide, Brain