Myocardial dysfunction in subarachnoid hemorrhage: prognostication by echo cardiography and cardiac enzymes. A prospective study.
BACKGROUND
The myocardial dysfunction in nontraumatic sub-arachnoid hemorrhage (SAH) is not well understood. Borderline elevations of cardiac biomarkers, electrocardiographic repolarization abnormalities and systolic dysfunction have been reported but the clinical significance of these abnormalities is uncertain.


METHODS
Patients without history of cardiac disease were prospectively evaluated for cardiac dysfunction. Myocardial regional wall motion and left ventricular ejection fraction (LVEF) were serially studied by transthoracic echocardiogram along with cardiac enzymes.


RESULTS
The mean age of the study population was 53 years. Majority of the patients had aneurysms (N = 38). The mean LVEF was 55 +/- 15%. Eight patients had evidence of WMA, mostly global hypokinesia (63%). The mean LVEF of patients with WMA was significantly lower compared to those without WMA (p < 0.001) at day 0. Systolic function recovered in 25% of these patients. The mean value of troponin was significantly higher in those with WMA (p < 0.001) and mean GCS upon admission was significantly lower (p < 0.001). On multivariate analysis, WMA were associated with poor GCS (p < 0.01) and increased hospitalization (P < 0.01).


CONCLUSIONS
WMA with systolic dysfunction occurred in 20% of patients and recovered within 3 days in 25%. Patients with evidence of WMA had a significant myocardial dysfunction, higher troponin levels and poor GCS.
Vannemreddy
Prasad
P
Department of Neurosurgery, LSUHSC-Shreveport, Shreveport, LA 71103, USA. pvanne@lsuhsc.edu
Venkatesh
Prasanna
P
Dinesh
Kumar
K
Reddy
Pratap
P
Nanda
Anil
A
D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis / Q000201:enzymology / Q000209:etiology; D052279:Creatine Kinase, MB Form / Q000378:metabolism*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D019210:Troponin I / Q000378:metabolism*
D019210:Troponin I; D052279:Creatine Kinase, MB Form