Long-Term Outcomes for Different Forms of Stress Cardiomyopathy After Surgical Treatment for Subarachnoid Hemorrhage

Abstract

Background Stress-induced cardiomyopathy (SCM) after subarachnoid hemorrhage (SAH) includes predominant apical or basal regional left ventricular dysfunction (RLVD) with concomitant changes in electrocardiogram or increase in cardiac enzymes. We hypothesized that difference in outcome is associated with the type of RLVD after SAH. Methods We studied a single-center retrospective cohort of SAH patients hospitalized between 2000 and 2010 with follow-up until 2013. We classified patients who had an echocardiogram for clinically indicated reasons according to the predominate location of RLVD as classic SCM-apical form and variant SCM-basal form. A Cox proportional hazard model and logistic regression were used to estimate risk for death and hospital complications associated with different RLVD, after adjustment for propensity to undergo echocardiography given clinical characteristics on admission. Results Among 715 SAH patients 28% (200/715) had an echocardiogram for clinical evidence of cardiac dysfunction during hospitalization, the most common being acute LV dysfunction, suspected acute ischemic event, changes in electrocardiogram and cardiac enzymes and arrhythmia. SCM was present in 59 patients (8% of all cohort and 30% of patients with echocardiogram, respectively) with similar distribution of SCM-basal (25/59) and SCM-Apical forms (34/59). SAH patients who had an echocardiogram for clinically indicated reasons had a significantly decreased risk-adjusted long-term survival compared to those without an echocardiogram, regardless of the presence of RLVD. SCM-basal was associated with cardiac complications (OR 6.1, 99% CI 1.8–20.2) and severe sepsis (OR 5.3 99% CI 1.6–17.2). Conclusions SAH patients with echocardiogram for a clinically indicated reason have a decreased long-term survival, regardless of the presence of RLVD. The association between severe sepsis and SCM-basal warrants future studies to determine their potential synergistic effect on LV systolic dysfunction among SAH patients.

Impact of Acute Cardiac Complications After Subarachnoid Hemorrhage on Long-Term Mortality and Cardiovascular Events

“…To the best of our knowledge, there are only two studies on long-term complications and cardiac events after SAH [ 22 , 23 ]. Consistent with the present study, they revealed an increased risk of death, especially early on after SAH, and an increased risk of cardiac events.…”

“…One of these studies was limited by its design as a registry study, with no detailed data regarding which cardiac complications affected each SAH patient [ 22 ]. The other study reported on only the association between stress cardiomyopathy and death [ 23 ].…”

“…Increasing evidence indicates that minor, subclinical troponin release and stress cardiomyopathy are associated with an increased risk of death and adverse cardiovascular outcomes in other patient categories [ 18 – 21 ]. Therefore, SAH patients presenting with cardiac complications are potentially at high risk for later cardiovascular events but these associations have barely been studied [ 22 , 23 ].…”

Neurogenic stress cardiomyopathy following aneurysmal subarachnoid haemorrhage: a literature review

“…As reported by Sugimoto et al the reduction of LV ejection fraction (below 50%) was observed in up to 62% of patients. However, the average LV EF of all patients was approximately 40% [49,51]. A study by Ahmadian et al reported similar prevalence: 55.7% of patients had LV EF between 40-60%, and only 6.6% of patients had LV EF lower than 40% [33].…”

“…Difficulties to achieve the blood pressure goals for haemodynamic augmentation because of low cardiac output are reported. In this situation, increased doses of inotropes and vasopressors could worsen hypotension and can determine secondary brain injury [51]. When high doses of vasopressors and inotropes are ineffective, the management using IABP may be indicated [56].…”