title: Neurogenic Stress Cardiomyopathy After Aneurysmal Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Neurogenic stress cardiomyopathy (NSC) is a known complication of aneurysmal subarachnoid hemorrhage (SAH). Detailed analyses of risk factors for its occurrence across large cohorts are relatively sparse.
  
  
  METHODS
  A consecutive group of 300 patients with aneurysmal SAH was reviewed for the presence of markers of myocardial injury, including electrocardiogram changes (long QT, T-wave inversion), elevated plasma troponin levels (≥0.1), and echocardiogram findings (decreased ejection fraction and wall motion abnormalities). NSC was defined as the presence of at least 1 marker of myocardial injury. Univariate and multivariate analyses were conducted to assess the correlation of NSC and individual markers of myocardial injury with age, gender, medical comorbidities, medications, current smoking status, Hunt-Hess grade, and Fisher grade. Medical comorbidities were assessed based on reported medical history or reported use of comorbidity-specific medications at the time of presentation.
  
  
  RESULTS
  Across the cohort, 27% of patients had a plasma troponin elevation of at least 0.1; 13%, a prolonged QT interval; 16%, new T-wave inversions; 18%, a depressed ejection fraction (<55%); and 15%, echocardiographic wall motion abnormalities. After a multivariate analysis, significant risk factors for NSC included higher Hunt-Hess grade on presentation (odds ratio [OR] = 2.33, P = 4.52 × 10(-6)), current smoking status (OR = 2.00, P = 0.030), and older age (OR = 1.03, P = 0.048). Hypertension was protective against NSC (OR = 0.48, P = 0.031). Patient gender, hyperlipidemia, diabetes, coronary artery disease, statin use, beta blocker use, angiotensin-converting enzyme inhibitor use, aspirin use, and thicker SAH (Fisher grade 3) were not significant risk factors for NSC.
  
  
  CONCLUSIONS
  Higher Hunt-Hess grade, current smoking status, lack of hypertension, and older age were the strongest predictors of NSC.
authors: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Athar N
authors: AN
authors: Malik
authors: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: bgross1@partners.org.
authors: Bradley A
authors: BA
authors: Gross
authors: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Pui Man
authors: PM
authors: Rosalind Lai
authors: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Ziev B
authors: ZB
authors: Moses
authors: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Rose
authors: R
authors: Du
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000209:etiology*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013312:Stress, Physiological; D013318:Stroke Volume; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D014463:Ultrasonography
chemical_list: D019210:Troponin I
keywords: Aneurysm; Myocardial; Neurogenic stress cardiomyopathy; Stress; Stunning; Subarachnoid hemorrhage; Troponin
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