title: Impact of transpulmonary thermodilution-based cardiac contractility and extravascular lung water measurements on clinical outcome of patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage: a retrospective observational study.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TCM) is a life-threatening systemic consequence early after subarachnoid hemorrhage (SAH), but precise hemodynamics and related outcome have not been studied. The purpose of this study was to investigate the TCM-induced cardiac function by transpulmonary thermodilution and its impact on clinical outcome of SAH.
  
  
  METHODS
  We retrospectively analyzed 46 consecutive postoperative SAH patients who developed TCM. Patients were divided into two groups of echocardiographic left ventricular ejection fraction (LVEF) < 40% (TCM with left ventricular (LV) dysfunction) and LVEF ≥40% (TCM without LV dysfunction). Cardiac function index (CFI) and extravascular lung water index (ELWI) were monitored by transpulmonary thermodilution, in parallel with serial measurements of echocardiographic parameters and blood biochemical markers.
  
  
  RESULTS
  Transpulmonary thermodilution-derived cardiac function index (CFI) was significantly correlated with (LVEF) (r = 0.82, P < 0.0001). The CFI between day 0 to day 7 was significantly lower in patients with LV dysfunction (LVEF <40%) than in patients with LVEF ≥40% (P < 0.05). CFI had a better ability than cardiac output to detect cardiac dysfunction (LVEF < 40%) (area under the curve: 0.85 ± 0.02; P < 0.001). A CFI value of < 4.2 min-1 had a sensitivity of 82% and specificity of 84% for detecting LVEF <40%. The CFI < 4.2 min-1 was associated with delayed cerebral ischemia (DCI) (odds ratio (OR), 2.14; 95% confidence interval (CI), 1.33-2.86; P = 0.004) and poor 3-month functional outcome on modified Rankin Scale of 4-6 (OR, 1.87; 95% CI, 1.06-3.29; P = 0.02). An extravascular lung water index (ELWI) > 14 mL/kg after day 4 increased the risk of poor functional outcome at 3-month follow-up (OR, 2.10; 95% CI, 1.11-3.97; P = 0.04).
  
  
  CONCLUSIONS
  Prolonged cardiac dysfunction and pulmonary edema increased the risk of DCI and poor 3-month functional outcome in patients with SAH suffering from TCM. Serial measurements of CFI and ELWI by transpulmonary thermodilution may provide an easy bedside method of detecting early changes of the cardiopulmonary function in directing proper post-SAH treatment.
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Mutoh
authors.forename: Ken
authors.initials: K
authors.lastname: Kazumata
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Terasaka
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Taki
authors.forename: Akifumi
authors.initials: A
authors.lastname: Suzuki
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ishikawa
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D004452:Echocardiography; D015633:Extravascular Lung Water; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011654:Pulmonary Edema / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D054549:Takotsubo Cardiomyopathy / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D013815:Thermodilution / Q000379:methods*
chemical_list: D015415:Biomarkers
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