Takotsubo Cardiomyopathy as a Neurocardiogenic Injury after Subarachnoid Hemorrhage: Hemodynamics and Fluid Management

Mutoh, Tatsushi; Mutoh, Tomoko; Taki, Yasuyuki; TatsuyaIshikawa,

doi:10.5772/65011

Cited by 3 publications

(6 citation statements)

References 62 publications

(99 reference statements)

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“…Specifically, one of the well-known neurocardiogenic injuries after SAH is Tako-Tsubo syndrome, which is characterized by left ventricular apical ballooning and transient cardiac dysfunction in relation to increased catecholamine. Although Tako-Tsubo syndrome has been regarded as a transient syndrome, it has been noted that Tako-Tsubo syndrome can significantly contribute to the morbidity and mortality of SAH patients (29).…”

Section: Discussionmentioning

confidence: 99%

Serum Lactate Could Predict Mortality in Patients With Spontaneous Subarachnoid Hemorrhage in the Emergency Department

Kim

et al. 2020

Front. Neurol.

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Background: Serum lactate is a useful biomarker for prediction of mortality in critically ill patients. The purpose of this study was to identify if serum lactate could be used as a biomarker for predicting mortality in patients with subarachnoid hemorrhage (SAH) in the emergency department. Methods: This retrospective study enrolled 189 patients. Baseline demographic data and clinical characteristics of patients were obtained from medical record review. Multiple logistic regression analysis was performed to determine predictor variables significantly associated with mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of variables for mortality prediction in SAH. Results: Using multivariate logistic regression analysis, age [OR 1.05; 95% confidence interval (CI) 1.00-1.10; p = 0.037], Hunt and Hess scale score (OR 3.29; 95% CI 1.62-6.70; p = 0.001), serum lactate level (OR 1.33; 95% CI 1.03-1.74; p = 0.032), and serum glucose level (OR 1.01; 95% CI 1.00-1.02; p = 0.049) predicted overall mortality in SAH. The area under the ROC curve (AUC) value for the use of serum lactate level to predict mortality in SAH was 0.815 (95% CI 0.753-0.868) (p < 0.001). Conclusion: Serum lactate may be a useful biomarker for the early prediction of mortality in SAH patients in the emergency department.

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Section: Discussionmentioning

confidence: 99%

Serum Lactate Could Predict Mortality in Patients With Spontaneous Subarachnoid Hemorrhage in the Emergency Department

Kim

et al. 2020

Front. Neurol.

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“…Acute cardiac dysfunction is a life‐threatening systemic complication early after subarachnoid haemorrhage (SAH) that can contribute to triggering delayed cerebral ischaemia (DCI) . DCI or symptomatic cerebral vasospasm is the most popular and potentially treatable cause of secondary neurological injury after SAH .…”

Section: Introductionmentioning

confidence: 99%

“…There are also concerns of cerebral vasoconstriction even with the use of the most reliable vasopressor noradrenaline . The phosphodiesterase‐III inhibitor milrinone (MIL) may be an alternative option when inotropes are required but dobutamine is contraindicated due to tachycardia, left ventricular outflow obstruction or neurogenic cardiomyopathies …”

Section: Introductionmentioning

confidence: 99%

“…One key factor underlying EBI is acute cerebral hypoperfusion, which can be the intriguing phenomenon of DCI. Furthermore, neurogenic cardiac dysfunction such as Takotsubo cardiomyopathy and left ventricular failure often coexists with severe grade SAH to increase the risk of DCI and poor outcome, presumably due to restricted fluid therapy and worsening of EBI.…”

Section: Introductionmentioning

confidence: 99%

“…11 The phosphodiesterase-III inhibitor milrinone (MIL) may be an alternative option when inotropes are required but dobutamine is contraindicated due to tachycardia, left ventricular outflow obstruction or neurogenic cardiomyopathies. 1,[12][13][14] We hypothesized that application of MIL to the isoflurane postconditioning strategy may have potential beneficial effects on post-SAH EBI to stabilize the CBF and improve the outcome. However, little data is available regarding the therapeutic efficacy of cardiac support with intravenous MIL on EBI after SAH.…”

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confidence: 99%

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Acute cardiac support with intravenous milrinone promotes recovery from early brain injury in a murine model of severe subarachnoid haemorrhage

Mutoh

Nakamura

et al. 2017

Clin Exp Pharma Physio

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Early brain injury/ischaemia (EBI) is a serious complication early after subarachnoid haemorrhage (SAH) that contributes to development of delayed cerebral ischaemia (DCI). This study aimed to determine the role of inotropic cardiac support using milrinone (MIL) on restoring acute cerebral hypoperfusion attributable to EBI and improving outcomes after experimental SAH. Forty-three male C57BL/6 mice were assigned to either sham surgery (SAH-sham), SAH induced by endovascular perforation plus postconditioning with 2% isoflurane (Control), or SAH plus isoflurane combined with MIL with and without hypoxia-inducible factor inhibitor (HIF-I) pretreatment. Cardiac output (CO) during intravenous MIL infusion (0.25-0.75 μg/kg/min) between 1.5 and 2.5 hours after SAH induction was monitored with Doppler echocardiography. Magnetic resonance imaging (MRI)-continuous arterial spin labelling was used for quantitative cerebral blood flow (CBF) measurements. Neurobehavioral function was assessed daily by neurological score and open field test. DCI was analyzed 3 days later by determining infarction on MRI. Mild reduction of cardiac output (CO) and global cerebral blood flow (CBF) depression were notable early after SAH. MIL increased CO in a dose-dependent manner (P<.001), which was accompanied by improved hypoperfusion, incidence of DCI and functional recovery than Control (P<.05). The neuroprotective effects afforded by MIL or Control were attenuated by hypoxia-inducible factor (HIF) inhibition (P<.05). These results suggest that MIL improves acute hypoperfusion by its inotropic effect, leading to neurobehavioral improvement in mice after severe SAH, in which HIF may be acting as a critical mediator.

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Incidental cerebral aneurysm after takotsubo cardiomyopathy: A case report

Amaro,

Sgarbi,

Vieira

et al. 2023

Clinical Case Reports

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Takotsubo syndrome (TS) is an acute heart disease that mimics the typical features of acute coronary syndrome (ACS). TS is generally reported after subarachnoid hemorrhage (SAH) due to a ruptured aneurysm, and has an incidence rate of 0.8 (17%). Here, we report a rare case of TS with unruptured intracranial aneurism. A 54‐year‐old woman had a history of systemic arterial hypertension and migraine. She went to a secondary hospital 2 h after sudden‐onset chest pain, which irradiated to the left upper limb and back. The initial electrocardiogram (ECG) was normal but showed a troponin curve, which led us to suspect acute non‐ST elevation myocardial infarction. Serial ECG showed dynamic changes in ST‐segment elevation in DIII, AvF, V5, and V6. Emergency cardiac catheterisation was performed and did not show any obstructive lesions. However, ventriculography revealed hypokinesia of the inferoapical wall. During hospitalization, the patient had a severe refractory headache. Computed tomography (CT) and CT angiography were performed, which identified “mirror” saccular aneurysms. A supraclinoid internal carotid artery aneurysm was embolized with two stents. The patient's condition progressed satisfactorily. The association between takotsubo syndrome and aneurysmal SAH with some populations has already been reported. Due to this prior knowledge, and severe headache, it was necessary to perform screening for SAH and the discovery of an unruptured aneurysm in this case report. The present case report differs from most reported cases of takotsubo syndrome described in the literature because it presents unruptured mirror aneurysms, while most cases are diagnosed after intracranial hemorrhage.

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Takotsubo Cardiomyopathy as a Neurocardiogenic Injury after Subarachnoid Hemorrhage: Hemodynamics and Fluid Management

Cited by 3 publications

References 62 publications

Serum Lactate Could Predict Mortality in Patients With Spontaneous Subarachnoid Hemorrhage in the Emergency Department

Serum Lactate Could Predict Mortality in Patients With Spontaneous Subarachnoid Hemorrhage in the Emergency Department

Acute cardiac support with intravenous milrinone promotes recovery from early brain injury in a murine model of severe subarachnoid haemorrhage

Incidental cerebral aneurysm after takotsubo cardiomyopathy: A case report

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