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Subarachnoid hemorrhage (SAH) is associated with reversible left ventricular dysfunction. However, the incidence of Takotsubo's cardiomyopathy (TCMP) in patients with SAH has not been well identified in large cohorts.
We retrospectively identified patients with aneurysmal SAH admitted to the neurological Intensive Care Unit (ICU) at a tertiary care hospital from January 2005 through December 2011. Patient demographics, clinical characteristics and echocardiography findings were collected. TCMP was defined by the presence of all four of the following diagnostic criteria: (1) The presence of transient hypokinesis, akinesis or dyskinesis in the left ventricular mid and apical segments, or the presence of regional wall motion abnormalities that extend beyond a single epicardial vascular distribution, (2) documentation of resolution of echocardiographic changes (3) new ECG abnormalities or elevation of cardiac troponin levels, (4) and changes must not be secondary to coronary artery disease. Severity of SAH was assessed by the Hunt and Hess (H&H) score which ranges from 0 to 5, with a score of 5 being very severe.
A total of 2,276 patients with aneurysmal SAH were identified during the study period. Echocardiograms were available for 828 (36.3%) patients. Nineteen (0.8%) patients met the criteria for TCMP. All patients with TCMP were female, with a mean age of 45 years (range 32-63). The majority of patients with TCMP were white (58%) and had a high H&H score of > 3 (89.5%). The mean ejection fraction (EF) at baseline was 27% (range 10-45%) and the mean EF at recovery was 56% (range 45-65%). The average time to myocardial function recovery was 8.7 days (range 2-25 days). Mean troponin level was 5.1ng/ml while mean CPK-MB level was 101.8 ng/ml. The average ICU stay was 19 days. Five out of the 19 cases (26.3%) died during hospitalization, compared to 315 (13.8%) deaths in the study population (p=0.22).
Aneurysmal subarachnoid hemorrhage is a recognized cause of Takotsubo's cardiomyopathy which developed in 0.8% of this cohort. It is more likely to develop in women with severe SAH and is associated with a prolonged ICU stay and high in-hospital mortality.
Oral Contributions South, Room 102
Saturday, March 09, 2013, 8:00 a.m.-8:15 a.m.
Session Title: Heart Failure Pathogenesis and Therapy
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 905-3
- 2013 American College of Cardiology Foundation