title: Clinical outcomes after neurogenic stress induced cardiomyopathy in aneurysmal sub-arachnoid hemorrhage: a prospective cohort study.
abstract: BACKGROUND
  Neurogenic stress cardiomyopathy (NCM) has been associated with poor outcomes in the setting of aneurysmal subarachnoid hemorrhage (aSAH). Much less is known regarding recovery of cardiac function. The aim of this prospective cohort study was to study the rate of early cardiac recovery after NCM and the potential effect of NCM on short term functional recovery. A secondary aim sought to determine whether certain biomarkers may be associated with the development of NCM.
  
  
  METHODS
  Patients with confirmed aSAH between November 2012 and October 2013 were prospectively enrolled and received echocardiograms within 48 h of admission. Ejection fraction (%) and regional wall motion abnormality score index (RWMI) were noted. All patients with confirmed aSAH had a troponin and BNP level drawn on admission. Patients with confirmed NCM received a follow up echocardiogram 7-21 days after the initial echocardiogram. Clinical follow up at 3 months evaluated mortality, mRS and mBI scores.
  
  
  RESULTS
  63 patients with confirmed aSAH were enrolled. In this cohort 11 (17%) patients were confirmed to have NCM. The NCM group had higher in-hospital mortality [n = 4(36.4%)] compared to the non-NCM group [n = 5(9.6%)] (p = .021). At 3 months the development of NCM was associated with an unfavorable mRS (p = 0.042) and mBI (p = 0.005). Both an elevated BNP (> 100 pg/mL) and elevated troponin (>0.3 mg/dL) were associated with the development of NCM. Follow-up echocardiograms were performed within 21 days of admission on 8 patients with NCM. An abnormal RWMI of 1.5 or higher was present in 5(71%) patients.
  
  
  CONCLUSIONS
  NCM is a frequent complication associated with aSAH. The onset of the disease occurs early in the course of aSAH and an elevated BNP and troponin may be associated with the onset of NCM. Cardiac function often remains impaired during the acute recovery phase potentially impeding resuscitation during this period. The routine use of short term follow-up echocardiography may be recommended.
authors.affiliation: Hartford Hospital, Department of Neurosurgery, 80 Seymour Street, Hartford 06102, USA. Electronic address: kent.kilbourn@hhchealth.org.
authors.forename: Kent J
authors.initials: KJ
authors.lastname: Kilbourn
authors.affiliation: Hartford Hospital, Division of Cardiology, 80 Seymour Street, Hartford 06102, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Ching
authors.affiliation: Hartford Hospital, Division of Cardiology, 80 Seymour Street, Hartford 06102, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Silverman
authors.affiliation: University of Connecticut Health Center, Department of Neurology, 263 Farmington Avenue, Farmington 06030, USA.
authors.forename: Louise
authors.initials: L
authors.lastname: McCullough
authors.affiliation: Hartford Hospital, Department of Neurosurgery, 80 Seymour Street, Hartford 06102, USA; University of Connecticut Health Center, Department of Neurology, 263 Farmington Avenue, Farmington 06030, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D020127:Recovery of Function / Q000502:physiology*; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D054549:Takotsubo Cardiomyopathy / Q000209:etiology* / Q000503:physiopathology; D014336:Troponin / Q000097:blood
chemical_list: D014336:Troponin; D020097:Natriuretic Peptide, Brain
keywords: Aneurysmal subarachnoid hemorrhage; Echocardiography; Neurogenic stress cardiomyopathy; Tako-tsubo