Importance of Detection of Segmental Wall Motion Abnormalities of Left Ventricle in Nontraumatic Subarachnoid Hemorrhage: A Prospective Study

Jyotsna, Maddury; Prasad, Vannemreddy; Garre, Indrani; Trikamji, Bhavesh

doi:10.1111/j.1540-8175.2009.01080.x

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…68,90,91 Nimodipine, a calcium channel blocker shown to improve outcomes in vasospasm, is a potent vasodilator and can lead to hypotension, which can be detrimental in patients with NSM. Although the American Heart Association 92 and NCS guidelines 69 no longer recommend triple-H therapy as the standard of care for vasospasm, it continues to be used widely as a therapeutic option. When used in the setting of NSM, efficacy of triple-H therapy is likely to be limited because maintaining permissive hypertension decreases cardiac output and increases myocardial oxygen demand, while hemodilution and subsequent decrease in oxygen delivery predispose the myocardium to further injury.…”

Section: Introductionmentioning

confidence: 99%

“…The overall recovery rates range from 66% to 78%, with gradual recovery in 2 weeks. 13,92 The prevalence of NSM is highest within the first 48 hours following SAH, and then declines over the course of the week. 13 Studies on TCM have shown complete recovery in 2 weeks, with a recurrence rate of less than 10% during a 3- to 4-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Neurogenic Stunned Myocardium Following Acute Subarachnoid Hemorrhage

Murthy

Shah

Rao

et al. 2013

J Intensive Care Med

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Neurogenic stunned myocardium (NSM) is a triad of transient left ventricular dysfunction, electrocardiogram changes, and elevation in cardiac enzymes, often mimicking a myocardial infarction. It has been described following acute brain injury. The purported mechanism is catecholamine excess resulting in cardiac dysfunction. From the clinical standpoint, the most frequently encountered electrocardiographic changes are QTc prolongation and ST-T changes, with modest elevations in troponin levels. Basal and mid-ventricular segments of the left ventricle are most commonly involved. NSM poses therapeutic challenges when it occurs secondary to aneurysmal subarachnoid hemorrhage, particularly in the setting of coexisting vasospasm. Overall, NSM carries good prognosis if recognized early, with appropriate management of hemodynamic and cardiopulmonary parameters.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurogenic Stunned Myocardium Following Acute Subarachnoid Hemorrhage

Murthy

Shah

Rao

et al. 2013

J Intensive Care Med

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“…Our study adds to the evidence that the variant form may be as common as the more frequently reported classic form while confirming previously reported rates of SCM in SAH patients between 3 and 28%. 2,4,9,18,19,36–39 After adjustment with high-dimensional propensity score regression, in spite of the increase in hospital complications and resource utilization, short and long-term survival were not different between patients with either SCM form in comparison to patients without RLVD but were lower compared to patients who did not have clinical cardiac dysfunction requiring an echocardiographic evaluation. We observed no difference in cardiovascular-specific mortality rate after discharge.…”

Section: Discussionmentioning

confidence: 92%

“…10,15–17 Most studies reporting SCM as an independent predictor of hospital death after SAH include not only patients undergoing surgical treatment for prevention of rebleeding but also those who were not treated surgically, often due to poor prognosis. 2,18,19 It remains unclear if certain patterns of regional left ventricular dysfunction are more prevalent or predictive of poor outcomes, including long-term survival and cardiovascular death, depending on whether the patient undergoes surgical treatment for SAH. 14,20,21 …”

Section: Introductionmentioning

confidence: 99%

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

Ozrazgat‐Baslanti

Mahanna

Malik

et al. 2016

Anesthesia &Amp; Analgesia

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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.

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“…1 and Supplemental Table 1 in the Supplemental Digital Content, http://links.lww.com/EJA/A819). As reported in Table 1, we finally included 19 14,21,27–43 prospective and 4 41,44–46 retrospective observational studies, overall enrolling 3511 patients with a median [IQR] age of 55 [54 to 57] years of whom 61% were female (Table 1). Neurological status and SAH characteristics at admission are reported in the Supplemental Table 2 in the Supplemental Digital Content, http://links.lww.com/EJA/A819.…”

Section: Resultsmentioning

confidence: 99%

Cardiac dysfunction in patients affected by subarachnoid haemorrhage affects in-hospital mortality

Messina

Longhitano

Zanza

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Subarachnoid haemorrhage (SAH) is a lifethreatening condition with associated brain damage. Moreover, SAH is associated with a massive release of catecholamines, which may promote cardiac injury and dysfunction, possibly leading to haemodynamic instability, which in turn may influence a patient's outcome.OBJECTIVES To study the prevalence of cardiac dysfunction (as assessed by echocardiography) in patients with SAH and its effect on clinical outcomes. DESIGN Systematic review of observational studies.DATA SOURCES We performed a systematic search over the last 20 years on MEDLINE and EMBASE databases.ELIGIBILITY CRITERIA Studies reporting echocardiography findings in adult patients with SAH admitted to intensive care. Primary outcomes were in-hospital mortality and poor neurological outcome according to the presence or absence of cardiac dysfunction. RESULTSWe included a total of 23 studies (4 retrospective) enrolling 3511 patients. The cumulative frequency of cardiac dysfunction was 21% (725 patients), reported as regional wall motion abnormality in the vast majority of studies (63%). Due to the heterogeneity of clinical outcome data reporting, a quantitative analysis was carried out only for in-hospital mortality. Cardiac dysfunction was associated with a higher in-hospital mortality [odds ratio 2.69 (1.64 to 4.41); P < 0.001; I 2 ¼ 63%]. The GRADE of evidence assessment resulted in very low certainty of evidence.CONCLUSION About one in five patients with SAH develops cardiac dysfunction, which seems to be associated with higher in-hospital mortality. The consistency of cardiac and neurological data reporting is lacking, reducing the comparability of the studies in this field.

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Importance of Detection of Segmental Wall Motion Abnormalities of Left Ventricle in Nontraumatic Subarachnoid Hemorrhage: A Prospective Study

Abstract: Transient SWMA can occur due to aneurysmal SAH itself and when associated with LV dysfunction, it had a higher mortality. (Echocardiography 2010;27:496-500).

Cited by 10 publications

References 12 publications

Neurogenic Stunned Myocardium Following Acute Subarachnoid Hemorrhage

Neurogenic Stunned Myocardium Following Acute Subarachnoid Hemorrhage

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

Cardiac dysfunction in patients affected by subarachnoid haemorrhage affects in-hospital mortality

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