Cardiac injury after subarachnoid hemorrhage is independent of the type of aneurysm therapy.
OBJECTIVE
Subarachnoid hemorrhage (SAH) is associated with cardiac injury and dysfunction. Whether aneurysm clipping versus coiling has a differential effect on the risk of troponin release and left ventricular (LV) dysfunction after SAH is unknown. It is hypothesized that aneurysm treatment does not affect the risk of developing cardiac injury and dysfunction.


METHODS
The study included 172 consecutive SAH patients who underwent clipping (n = 109) or coiling (n = 63) aneurysm therapy. Hemodynamic data were collected, cardiac troponin I was measured, and echocardiography was performed on the 1st, 3rd, and 6th days after enrollment. A cardiac troponin I measurement of more than 1.0 microg/L was considered abnormal. For each echocardiographic examination, a blinded observer measured LV ejection fraction (abnormal if <50%) and quantified LV regional wall motion abnormalities. The incidence of cardiac outcomes in the treatment groups was compared using odds ratios (ORs).


RESULTS
The coiled patients were older than the clipped patients (mean age, 59 +/- 13 yr versus 53 +/- 12 yr; t test, P < 0.001) and were more likely to have posterior aneurysms (33% versus 18%; chi(2) test, P = 0.019). There were no significant between-group differences in the risk of cardiac troponin I release (coil 21% versus clip 19%; OR = 0.89, P = 0.789), regional wall motion abnormalities (33% versus 28%; OR = 0.76, P = 0.422), or LV ejection fraction lower than 50% (16% versus 17%; OR = 1.06, P = 0.892). No patient died of cardiac causes (heart failure, myocardial infarction, or arrhythmia).


CONCLUSIONS
Surgical and endovascular aneurysm therapies were associated with similar risks of cardiac injury and dysfunction after SAH. The presence of neurocardiogenic injury should not affect aneurysm treatment decisions.
Miss
Jacob C
JC
Department of Medicine, University of California, San Francisco, California 94143-0124, USA.
Kopelnik
Alexander
A
Fisher
Landis A
LA
Tung
Poyee P
PP
Banki
Nader M
NM
Lawton
Michael T
MT
Smith
Wade S
WS
Dowd
Christopher F
CF
Zaroff
Jonathan G
JG
D015331:Cohort Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D014336:Troponin / Q000378:metabolism; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000209:etiology*
D014336:Troponin