title: Impairment of cardiac metabolism and sympathetic innervation after aneurysmal subarachnoid hemorrhage: a nuclear medicine imaging study.
abstract: BACKGROUND
  Although aneurysmal subarachnoid hemorrhage (SAH) is often complicated by myocardial injury, whether this neurogenic cardiomyopathy is associated with the modification of cardiac metabolism is unknown. This study sought to explore, by positron emission tomography/computed tomography, the presence of altered cardiac glucose metabolism after SAH.
  
  
  METHODS
  During a 16-month period, 30 SAH acute phase patients underwent myocardial (18)F- fluorodesoxyglucose positron emission tomography ((18)F-FDGPET), (99m)Tc-tetrofosmin and (123)I-meta-iodobenzylguanidine ((123)I-mIBG) scintigraphy, respectively, assessing glucose metabolism, cardiac perfusion, and sympathetic innervation. Patients with initial abnormalities were followed monthly for two months for (18)F-FDG, and six months later for (123)I-mIBG.
  
  
  RESULTS
  In this SAH population, acute cardiac metabolic disturbance was observed in 83% of patients (n = 25), and sympathetic innervation disturbance affected 90% (n = 27). Myocardial perfusion was normal for all patients. The topography and extent of metabolic defects and innervation abnormalities largely overlapped. Follow-up showed rapid improvement of glucose metabolism in one or two months. Normalization of sympathetic innervation was slower; only 27% of patients (n = 8) exhibited normal (123)I-mIBG scintigraphy after six months. Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes.
  
  
  CONCLUSIONS
  These findings support the hypothesis of neurogenic myocardial stunning after SAH. In hemodynamically stable acute phase SAH patients, cardiomyopathy is characterized by diffuse and heterogeneous (18)F-FDG and (123)I-mIBG uptake defect.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01218191. Registered 6 October 2010.
authors: Bertrand
authors: B
authors: Prunet
authors: Mathieu
authors: M
authors: Basely
authors: Erwan
authors: E
authors: D'Aranda
authors: Pierre
authors: P
authors: Cambefort
authors: Frédéric
authors: F
authors: Pons
authors: Sébastien
authors: S
authors: Cimarelli
authors: Arnaud
authors: A
authors: Dagain
authors: Nicolas
authors: N
authors: Desse
authors: Jean-Brice
authors: JB
authors: Veyrieres
authors: Christophe
authors: C
authors: Jego
authors: Guillaume
authors: G
authors: Lacroix
authors: Pierre
authors: P
authors: Esnault
authors: Henry
authors: H
authors: Boret
authors: Philippe
authors: P
authors: Goutorbe
authors: Emmanuel
authors: E
authors: Bussy
authors: Gilbert
authors: G
authors: Habib
authors: Eric
authors: E
authors: Meaudre
mesh_terms: D019797:3-Iodobenzylguanidine; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006321:Heart / Q000294:innervation*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000378:metabolism*; D007457:Iodine Radioisotopes; D017682:Myocardial Stunning / Q000209:etiology; D009206:Myocardium / Q000378:metabolism*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D049268:Positron-Emission Tomography; D011788:Quality of Life; D019275:Radiopharmaceuticals; D012422:Rupture, Spontaneous; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000378:metabolism*; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D015899:Tomography, Emission-Computed, Single-Photon; D020107:Troponin T / Q000097:blood
chemical_list: D007457:Iodine Radioisotopes; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D020107:Troponin T; D019788:Fluorodeoxyglucose F18; D019797:3-Iodobenzylguanidine; C078700:technetium tc-99m tetrofosmin; D005947:Glucose