Predictors of Left Ventricular Regional Wall Motion Abnormalities After Subarachnoid Hemorrhage

Kothavale, Avinash A.; Banki, Nader M.; Kopelnik, Alexander; Yarlagadda, Sirisha; Lawton, Michael T.; Ko, Nerissa; Smith, Wade S.; Drew, Barbara J.; Foster, Elyse; Zaroff, Jonathan G.

doi:10.1385/ncc:4:3:199

Cited by 104 publications

(82 citation statements)

References 29 publications

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“…This observation is consistent with the previous finding that myocardial damage was associated with more severe SAH grades. 10,11,29) Moreover, we found that RWMA predicts poor outcome after SAH, suggesting RWMA in SAH reflects adverse intracranial factors. In the present study, global LV dysfunction (LVEF < 50%) did not predict poor outcome after SAH.…”

Section: Dysfunction In Sahmentioning

confidence: 60%

“…4,12,13,28,29) We also have shown that the most frequently abnormal LV segments were the middle ventricular portions of the anterolateral, posterolateral, and inferior walls and basal portion of the anterior wall. This pattern did not correlate with coronary artery distributions, suggesting SAH-associated heart damage is a form of neurocardiogenic injury.…”

Section: Dysfunction In Sahmentioning

confidence: 73%

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Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

et al. 2008

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SUMMARYLeft ventricular (LV) dysfunction generally occurs early in the course of subarachnoid hemorrhage (SAH). We evaluated the prognostic value of electrocardiographic (ECG) abnormalities and echocardiographic LV dysfunction evaluated shortly after SAH.We prospectively enrolled 47 SAH patients (62 ± 14 years, mean ± SD) who were admitted to the neurosurgical care unit of our institute. Neurological status was rated on the day of admission. Twelve-lead ECG and 2-dimensional echocardiography were recorded 2 ± 1 day after onset of SAH. ECG abnormalities (pathological Q-wave, ST-segment deviation, T-wave inversion, and QT prolongation) were evaluated and the incidences of global (LV ejection fraction < 50%) and segmental (regional wall motion abnormality [RWMA]) LV dysfunction were measured.During a follow-up period of 44 ± 23 days, 17 (36%) patients died. ECG abnormalities, LV ejection fraction < 50%, and RWMA were observed in 62%, 11%, and 28% of patients, respectively. Univariate Cox proportional hazards regression analysis revealed that neurological status, rate-corrected QT interval, LV ejection fraction, and RWMA were significant predictors of death. After adjustment for these significant clinical variables, and age and sex, independent predictors of mortality were neurological status and RWMA.RWMA may provide significant prognostic information in patients with SAH. (Int Heart J 2008; 49: 75-85)

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Section: Dysfunction In Sahmentioning

confidence: 60%

Section: Dysfunction In Sahmentioning

confidence: 73%

Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

et al. 2008

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] WMA occurs in patients with SAH with a reported incidence of 8% to 27%. 5,7,8 It has been hypothesized that massive release of catecholamine into the systemic circulation after SAH results in the nonischemic usually reversible myocardial injury.…”

mentioning

confidence: 99%

“…5,7,8 It has been hypothesized that massive release of catecholamine into the systemic circulation after SAH results in the nonischemic usually reversible myocardial injury. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In the cardiology literature, the possible role of estrogen in the pathogenesis of WMA has recently been suggested in patients with takotsubo (stress) cardiomyopathy (TCM). 16 -18 This hypothesis is based on the clinical observation that a majority of patients with TCM are postmenopausal women, whereas only a few young women are diagnosed with TCM.…”

mentioning

confidence: 99%

The Role of Norepinephrine and Estradiol in the Pathogenesis of Cardiac Wall Motion Abnormality Associated With Subarachnoid Hemorrhage

Sugimoto

Inamasu

Hirose

et al. 2012

Stroke

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Background and Purpose-The majority of patients with ventricular wall motion abnormality (WMA) associated with subarachnoid hemorrhage (SAH) are postmenopausal women. In addition to elevated catecholamine, the role of estrogen in the pathogenesis of WMA has recently been implicated. The objective of this study is to clarify the interrelation among catecholamine, estrogen, and WMA in patients with SAH. Methods-A retrospective analysis was performed on the medical records of 77 patients with SAH (23 men, 54 women) whose plasma levels of epinephrine, norepinephrine, and estradiol had been measured and echocardiograms had been obtained within 48 hours of SAH onset. Results-Twenty-four patients (31%) were found to sustain WMA on admission. Multivariate regression analysis revealed that decreased estradiol (Pϭ0.018; OR, 0.902) and elevated norepinephrine levels (Pϭ0.027; OR, 1.002) were associated with WMA. After quadrichotomization of 77 patients based on sex/WMA, plasma norepinephrine levels were markedly elevated in men with WMA, whereas estradiol levels were markedly decreased in women with WMA. Plasma norepinephrine and estradiol levels were not correlated. Fifty-four female patients with SAH were further quadrichotomized based on norepinephrine/estradiol levels with a threshold value of 1375 pg/mL for norepinephrine and 11 pg/mL for estradiol. The incidence of WMA in the high-norepinephrine/low-estradiol group was significantly higher than the low-norepinephrine/high-estradiol group. Conclusions-To our knowledge, this is the first study to evaluate the interrelation among catecholamine, estrogen, and SAH-induced WMA. Lack of estradiol in postmenopausal women may predispose them to develop WMA after poor-grade SAH. However, the precise role of multiple sex hormones in SAH-induced WMA should be evaluated in future prospective studies. (Stroke. 2012;43:1897-1903.)

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“…Presentation includes transient lactic acidosis, cardiogenic shock, pulmonary edema, widespread T wave inversions, and reversible wall motion abnormalities [63]. One prospective study revealed a 18% (35% in Grade III-V) prevalence of wall motion abnormalities on echocardiogram in patients with aneurysmal SAH [64]. Takotsubo cardiac myopathy, also known as apical ballooning syndrome, is a subset of stunned myocardial injury seen most commonly in postmenopausal women and is associated with pulmonary edema and prolonged mechanical ventilation [65].…”

Section: Cardiac Complicationsmentioning

confidence: 99%

The Critical Care Management of Aneurysmal Subarachnoid Hemorrhage

Patel¹,

Samuels²

2012

Aneurysm

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Predictors of Left Ventricular Regional Wall Motion Abnormalities After Subarachnoid Hemorrhage

Abstract: RWMA were frequent after SAH. High-grade SAH, an elevation in cTi levels, a history of prior stimulant drug use, and tachycardia are independent predictors of RWMA.

Cited by 104 publications

References 29 publications

Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

The Role of Norepinephrine and Estradiol in the Pathogenesis of Cardiac Wall Motion Abnormality Associated With Subarachnoid Hemorrhage

The Critical Care Management of Aneurysmal Subarachnoid Hemorrhage

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