title: Long-Term Outcomes for Different Forms of Stress Cardiomyopathy After Surgical Treatment for Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Stress-induced cardiomyopathy (SCM) after subarachnoid hemorrhage (SAH) includes predominant apical or basal regional left ventricular dysfunction (RLVD) with concomitant changes in electrocardiogram or increase in cardiac enzymes. We hypothesized that difference in outcome is associated with the type of RLVD after SAH.
  
  
  METHODS
  We studied a single-center retrospective cohort of SAH patients hospitalized between 2000 and 2010 with follow-up until 2013. We classified patients who had an echocardiogram for clinically indicated reasons according to the predominate location of RLVD as classic SCM-apical form and variant SCM-basal form. A Cox proportional hazard model and logistic regression were used to estimate the risk for death and hospital complications associated with different RLVD after adjustment for propensity to undergo echocardiography given clinical characteristics on admission.
  
  
  RESULTS
  Among 715 SAH patients, 28% (200/715) had an echocardiogram for clinical evidence of cardiac dysfunction during hospitalization, the most common being acute left ventricular dysfunction, suspected acute ischemic event, changes in electrocardiogram and cardiac enzymes, and arrhythmia. SCM was present in 59 patients (8% of all cohort and 30% of patients with echocardiogram, respectively) with similar distribution of SCM-basal (25/59) and SCM-apical forms (34/59). SAH patients who had an echocardiogram for clinically indicated reasons had a significantly decreased risk-adjusted long-term survival compared with those without an echocardiogram, regardless of the presence of RLVD. SCM-basal form was associated with cardiac complications (odds ratio, 6.1; 99% confidence interval, 1.8-20.2) and severe sepsis (odds ratio, 5.3; 99% confidence interval, 1.6-17.2).
  
  
  CONCLUSIONS
  SAH patients with echocardiogram for a clinically indicated reason have a decreased long-term survival, regardless of the presence of RLVD. The association between severe sepsis and SCM-basal warrants future studies to determine their potential synergistic effect on left ventricular systolic dysfunction among SAH patients.
authors.affiliation: From the Departments of *Anesthesiology and †Medicine, University of Florida, Gainesville, Florida.
authors.forename: Azra
authors.initials: A
authors.lastname: Bihorac
authors.forename: Tezcan
authors.initials: T
authors.lastname: Ozrazgat-Baslanti
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mahanna
authors.forename: Seemab
authors.initials: S
authors.lastname: Malik
authors.forename: Peggy
authors.initials: P
authors.lastname: White
authors.forename: Matthew
authors.initials: M
authors.lastname: Sorensen
authors.forename: Brenda G
authors.initials: BG
authors.lastname: Fahy
authors.forename: John W
authors.initials: JW
authors.lastname: Petersen
mesh_terms: D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler; D005260:Female; D005431:Florida; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left