Cardiac manifestations of subarachnoid hemorrhage

A Ahmadian; A Mizzi; M Banasiak; K Downes; E M Camporesi; J Thompson Sullebarger; R Vasan; D Mangar; H R van Loveren; S Agazzi

Cardiac manifestations of subarachnoid hemorrhage

Heart Lung Vessel. 2013;5(3):168-78.

Authors

A Ahmadian¹, A Mizzi², M Banasiak¹, K Downes³, E M Camporesi⁴, J Thompson Sullebarger⁵, R Vasan¹, D Mangar⁶, H R van Loveren¹, S Agazzi¹

Affiliations

¹ Department of Neurosurgery, University of South Florida, Tampa, Florida.
² Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
³ Core Biostatistics, University of South Florida, Tampa, Florida.
⁴ Department of Surgery, University of South Florida, Tampa, Florida.
⁵ Florida Cardiology Institute, Tampa, Florida.
⁶ Florida Gulf-to-Bay Anesthesia, Tampa, Florida.

PMID: 24364008
PMCID: PMC3848675

Abstract

Introduction: Cardiac manifestations of intracranial subarachnoid hemorrhage patients include mild electrocardiogram variability, reversible left ventricular dysfunction (Takotsubo), non-ST elevation myocardial infarction, ST-elevation myocardial infarction and cardiac arrest, but their clinical relevance is unclear. The aim of the present study was to categorize the relative frequency of different cardiac abnormalities in patients with subarachnoid hemorrhage and determine the influence of each abnormality on outcome.

Methods: A retrospective review of 617 consecutive patients who presented with non-traumatic aneurysmal subarachnoid hemorrhage at our institution was performed. A cohort of 87 (14.1%) patients who required concomitantly cardiological evaluation was selected for subgroup univariate and multi-variable analysis of radiographic, clinical and cardiac data.

Results: Cardiac complications included myocardial infarction arrhythmia and congestive heart failure in 47%, 63% and 31% of the patients respectively. The overall mortality of our cohort (23%) was similar to that of national inpatient databases. In our cohort a high World Federation of Neurosurgical Surgeons grading scale and a troponin level >1.0 mcg/L were associated with a 33 times and 10 times higher risk of death respectively.

Conclusions: Among patients suffering from cardiac events at the time of aneurysmal subarachnoid hemorrhage, those with myocardial infarction and in particular those with a troponin level greater than 1.0 mcg/L had a 10 times increased risk of death.

Keywords: MI; SAH; Takotsubo stress cardiomyopathy; arrhythmia; cardiac outcomes; intracranial aneurysm; myocardial Infarction; subarachnoid hemorrhage.