Neurogenic Stress Cardiomyopathy After Aneurysmal Subarachnoid Hemorrhage

Abstract

Objective Neurogenic stress cardiomyopathy (NSC) is a known complication of aneurysmal subarachnoid hemorrhage (aSAH). Detailed analyses of risk factors for its occurrence across large cohorts are relatively sparse. Methods We reviewed a consecutive group of 300 patients with aSAH, evaluating for the presence of markers of myocardial injury including EKG changes (long QT, TWI), elevated plasma troponin levels (>=0.1), and echocardiogram findings (decreased ejection fraction and wall motion abnormalities). Neurogenic stress cardiomyopathy (NSC) was defined as the presence of at least one marker of myocardial injury. Univariate and multivariate analyses were conducted to assess the correlation of NSC as well as individual markers of myocardial injury with age, gender, medical comorbidities, medications, current smoking status, Hunt-Hess (HH) grade, and Fisher grade. Medical comorbidities were assessed based on reported medical history or reported use of comorbidity-specific medications at the time of presentation. Results Across the cohort, 27% of patients had a plasma troponin elevation of at least 0.1, 13% a prolonged QT interval, 16% new T wave inversions, 18% a depressed ejection fraction (less than 55%), and 15% echocardiographic wall motion abnormalities. After a multivariate analysis, significant risk factors for NSC included higher HH grade on presentation (OR 2.33, p = 4.52 × 10−6), current smoking status (OR 2.00, p = 0.030), and older age (OR 1.03, p = 0.048). Hypertension was protective against NSC (OR 0.48, p = 0.031). Patient gender, hyperlipidemia, diabetes, coronary artery disease, statin usage, beta blocker usage, ACE-inhibitor usage, aspirin usage, and thicker SAH (Fisher 3) were not significant risk factors for NSC. Conclusion Higher HH grade, current smoking status, lack of hypertension and older age were the strongest predictors of neurogenic stress cardiomyopathy.

Subarachnoid bleeding triggering Takotsubo syndrome

“…In a retrospective study of 46 SAB-triggered TTS patients the risk for ischemic stroke was increased among those with reduced systolic function [7]. In a study of 300 patients with SAB, 45 (15%) had neurogenic stress cardiomyopathy [8]. Risk factors for TTS were high Hunt-Hess-score (HHS), smoking, and old age [8].…”

“…In a study of 300 patients with SAB, 45 (15%) had neurogenic stress cardiomyopathy [8]. Risk factors for TTS were high Hunt-Hess-score (HHS), smoking, and old age [8]. In a study of 135 SAB patients undergoing echocardiography TTS was found in 25 (18.5%) [9].…”

Complete heart block as the presenting feature in subarachnoid haemorrhage

“…NSM is characterised by reversible left ventricular dysfunction and is hypothesised to result from a combination of hypothalamic dysfunction, catecholamine surges and myocardial perivascular lesions 16. There is no clear definition of diagnosis, but it resolves around severe cardiac dysfunction which may include elevation of troponin, ejection fraction <55% or significant ECG abnormalities17 and results in higher mortality and morbidity rates18 in patients after SAH. There is no specific therapy, and these patients undergo cardiorespiratory support measures until the cardiac dysfunction improves.…”

Can Levosimendan Be a Treatment Option in Subarachnoid Hemorrhage?

“…Literatürde NSK; "nörojenik afallamış miyokard" (neurogenic stunned myocardium), "nörojenik kardiyak afallama" (neurogenic cardiac stunning), "nörokardiyojenik hasarlanma" (neurocardiogenic injury) olarak da adlandırılmaktadır (4,8). Altta yatan patofizyolojiyi daha doğru bir şekilde yansıttığı için, NSK terimi daha yaygın olarak kullanılmaktadır (8).…”

“…Kalp debisini ve ortalama arter basıncını artırmak ve dolayısıyla serebral perfüzyon basıncını düzeltmek için kompansasyon mekanizmaları devreye girer. En önemli kompansasyon mekanizması olan sempatik aktivasyonun, NSK patofizyolojisinde rol oynadığı düşünülmektedir (5,8). NSK'nin patofizyolojisinde katekolaminlerin suçlanması görece yeni bir bilgidir.…”