title: Preadmission beta-blockers are associated with decreased incidence of neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Neurogenic stunned myocardium (NSM) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), with a significant impact on disease course. The presumed cause is catecholamine surge at the time of aneurysm rupture. Beta-blockers, which reduce the impact of the catecholamine surge, may decrease the risk of developing NSM.
  
  
  METHODS
  A chart review of 234 consecutive patients admitted to the Oregon Health and Science University Neurosurgery service between March 6, 2008 and June 23, 2010 with a diagnosis of aneurysmal SAH was performed. This group was further subdivided by patients who received echocardiograms on admission, by gender, and by the prehospital administration of β-blockers.
  
  
  RESULTS
  One hundred thirty of 234 patients had echocardiograms on or shortly after admission, and 18 of these developed NSM (13.8%). None of the 22 patients taking prehospital β-blockers developed NSM. Using the Fisher exact test to compare the 2 groups, patients who were administered prehospital β-blockers were significantly less likely to develop stunning compared to those who were not (P = .04). After correcting for other variables using multiple logistic regression analysis, the previous use of β-blockers was still found to be significantly associated with a decreased incidence of NSM after SAH (P = .049). There was no significant difference in hospital length of stay, peribleed stroke, vasospasm, or death. Of the 18 patients with stunning, 15 were women, 5 of whom were on estrogen supplementation. The mean peak troponin elevation of women who developed NSM on estrogen supplementation was significantly higher than for those who were not (mean peak troponin 9.97 ± 2.01 mg/dL; P < .001).
  
  
  CONCLUSIONS
  Prehospital β-blockers are associated with decreased risk of developing NSM in patients with aSAH. Estrogen may play an additional role in shaping the degree of NSM in women.
authors: Department of Neurology at Oregon Health and Science University, Portland, Oregon, USA. liangc@ohsu.edu
authors: Conrad W
authors: CW
authors: Liang
authors: Ricky
authors: R
authors: Chen
authors: Elizabeth
authors: E
authors: Macri
authors: Neeraj
authors: N
authors: Naval
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017682:Myocardial Stunning / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D009922:Oregon; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D013997:Time Factors; D014336:Troponin / Q000097:blood; D014463:Ultrasonography
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D014336:Troponin