title: Myocarditis in patients with subarachnoid hemorrhage: A histopathologic study.
abstract: Cardiac abnormalities after subarachnoid hemorrhage (SAH) such as electrocardiographic changes, echocardiographic wall motion abnormalities, and elevated troponin levels are independently associated with a poor prognosis. They are caused by catecholaminergic stress coinciding with influx of inflammatory cells into the heart. These abnormalities could be a sign of a myocarditis, potentially giving insight in pathophysiology and treatment options. These inflammatory cells are insufficiently characterized, and it is unknown whether myocarditis is associated with SAH. Myocardium of 25 patients who died of SAH and 18 controls was stained with antibodies identifying macrophages (CD68), lymphocytes (CD45), and neutrophil granulocytes (myeloperoxidase). Myocytolysis was visualized using complement staining (C3d). CD31 was used to identify putative thrombi. We used Mann-Whitney U testing for analysis. In the myocardium of SAH patients, the amount of myeloperoxidase-positive (P < .005), CD45-positive (P < .0005), and CD68-positive (P < .0005) cells was significantly higher compared to controls. Thrombi in intramyocardial arteries were found in 22 SAH patients and 1 control. Myocytolysis was found in 6 SAH patients but not in controls. Myocarditis, consisting of an influx of neutrophil granulocytes, lymphocytes, and macrophages, coinciding with myocytolysis and thrombi in intramyocardial arteries, occurs in patients with SAH but not in controls. These findings might explain the cardiac abnormalities after SAH and may have implications for treatment.
authors.affiliation: Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: vanderbilt@cardionetworks.org.
authors.forename: Ivo A C
authors.initials: IA
authors.lastname: van der Bilt
authors.affiliation: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Vendeville
authors.affiliation: Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Tim P
authors.initials: TP
authors.lastname: van de Hoef
authors.affiliation: Department of Pathology, ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiac Surgery, ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mark P V
authors.initials: MP
authors.lastname: Begieneman
authors.affiliation: Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Wim K
authors.initials: WK
authors.lastname: Lagrand
authors.affiliation: Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Johan M
authors.initials: JM
authors.lastname: Kros
authors.affiliation: Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Arthur A M
authors.initials: AA
authors.lastname: Wilde
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands; Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands.
authors.forename: Gabriel J E
authors.initials: GJ
authors.lastname: Rinkel
authors.affiliation: Department of Pathology, ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiac Surgery, ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hans W M
authors.initials: HW
authors.lastname: Niessen
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006098:Granulocytes / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008214:Lymphocytes / Q000473:pathology; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000209:etiology / Q000473:pathology*; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013927:Thrombosis / Q000150:complications
keywords: Cardiac abnormalities; Inflammation; Myocarditis; Outcome; Subarachnoid hemorrhage; Takotsubo