Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: An underappreciated ventricular dysfunction

Vivien H. Lee, Heidi M. Connolly, Jimmy R. Fulgham, Edward M. Manno, Robert D Jr. Brown, Eelco F M Wijdicks

Research output: Contribution to journalArticle

171 Citations (Scopus)

Abstract

Object. Neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage (SAH) is associated with a wide spectrum of reversible left ventricular wall motion abnormalities and includes a subset of patients with a pattern of apical akinesia and concomitant sparing of basal segments called "tako-tsubo cardiomyopathy." Methods. After obtaining institutional review board approval, the authors retrospectively identified among all patients admitted to the Mayo Clinic's Neurological Intensive Care Unit between January 1990 and January 2005 those with aneurysmal SAH who had met the echocardiographic criteria for tako-tsubo cardiomyopathy. Among 24 patients with SAH-induced reversible cardiac dysfunction, the authors identified eight with SAH-induced tako-tsubo cardiomyopathy. All eight patients were women with a mean age of 55.5 years (range 38.6-71.1). Seven patients presented with a poor-grade SAH, reflected by a Hunt and Hess grade of III or IV. Four patients underwent aneurysm clip application, and four underwent endovascular coil occlusion. The initial mean ejection fraction (EF) was 38% (range 25-55%), and the mean EF at recovery was 55% (range 40-68%). Cerebral vasospasm developed in six patients, but cerebral infarction developed in only three patients. Conclusions. The authors describe the largest cohort with aneurysmal SAH-induced tako-tsubo cardiomyopathy. In the SAH population, tako-tsubo cardiomyopathy predominates in postmenopausal women and is often associated with pulmonary edema, prolonged intubation, and cerebral vasospasm. Additional studies are warranted to understand the complex mechanism involved in tako-tsubo cardiomyopathy and its intriguing relationship to neurogenic stunned myocardium.

Original languageEnglish (US)
Pages (from-to)264-270
Number of pages7
JournalJournal of Neurosurgery
Volume105
Issue number2
DOIs
StatePublished - 2006

Fingerprint

Takotsubo Cardiomyopathy
Ventricular Dysfunction
Subarachnoid Hemorrhage
Myocardial Stunning
Intracranial Vasospasm
Research Ethics Committees
Cerebral Infarction
Pulmonary Edema
Surgical Instruments
Intubation
Aneurysm
Intensive Care Units

Keywords

  • Cardiac apical ballooning
  • Neurogenic stunned myocardium
  • Subarachnoid hemorrhage
  • Tako-tsubo cardiomyopathy

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage : An underappreciated ventricular dysfunction. / Lee, Vivien H.; Connolly, Heidi M.; Fulgham, Jimmy R.; Manno, Edward M.; Brown, Robert D Jr.; Wijdicks, Eelco F M.

In: Journal of Neurosurgery, Vol. 105, No. 2, 2006, p. 264-270.

Research output: Contribution to journalArticle

Lee, Vivien H. ; Connolly, Heidi M. ; Fulgham, Jimmy R. ; Manno, Edward M. ; Brown, Robert D Jr. ; Wijdicks, Eelco F M. / Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage : An underappreciated ventricular dysfunction. In: Journal of Neurosurgery. 2006 ; Vol. 105, No. 2. pp. 264-270.
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abstract = "Object. Neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage (SAH) is associated with a wide spectrum of reversible left ventricular wall motion abnormalities and includes a subset of patients with a pattern of apical akinesia and concomitant sparing of basal segments called {"}tako-tsubo cardiomyopathy.{"} Methods. After obtaining institutional review board approval, the authors retrospectively identified among all patients admitted to the Mayo Clinic's Neurological Intensive Care Unit between January 1990 and January 2005 those with aneurysmal SAH who had met the echocardiographic criteria for tako-tsubo cardiomyopathy. Among 24 patients with SAH-induced reversible cardiac dysfunction, the authors identified eight with SAH-induced tako-tsubo cardiomyopathy. All eight patients were women with a mean age of 55.5 years (range 38.6-71.1). Seven patients presented with a poor-grade SAH, reflected by a Hunt and Hess grade of III or IV. Four patients underwent aneurysm clip application, and four underwent endovascular coil occlusion. The initial mean ejection fraction (EF) was 38{\%} (range 25-55{\%}), and the mean EF at recovery was 55{\%} (range 40-68{\%}). Cerebral vasospasm developed in six patients, but cerebral infarction developed in only three patients. Conclusions. The authors describe the largest cohort with aneurysmal SAH-induced tako-tsubo cardiomyopathy. In the SAH population, tako-tsubo cardiomyopathy predominates in postmenopausal women and is often associated with pulmonary edema, prolonged intubation, and cerebral vasospasm. Additional studies are warranted to understand the complex mechanism involved in tako-tsubo cardiomyopathy and its intriguing relationship to neurogenic stunned myocardium.",
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AU - Lee, Vivien H.

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AU - Manno, Edward M.

AU - Brown, Robert D Jr.

AU - Wijdicks, Eelco F M

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N2 - Object. Neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage (SAH) is associated with a wide spectrum of reversible left ventricular wall motion abnormalities and includes a subset of patients with a pattern of apical akinesia and concomitant sparing of basal segments called "tako-tsubo cardiomyopathy." Methods. After obtaining institutional review board approval, the authors retrospectively identified among all patients admitted to the Mayo Clinic's Neurological Intensive Care Unit between January 1990 and January 2005 those with aneurysmal SAH who had met the echocardiographic criteria for tako-tsubo cardiomyopathy. Among 24 patients with SAH-induced reversible cardiac dysfunction, the authors identified eight with SAH-induced tako-tsubo cardiomyopathy. All eight patients were women with a mean age of 55.5 years (range 38.6-71.1). Seven patients presented with a poor-grade SAH, reflected by a Hunt and Hess grade of III or IV. Four patients underwent aneurysm clip application, and four underwent endovascular coil occlusion. The initial mean ejection fraction (EF) was 38% (range 25-55%), and the mean EF at recovery was 55% (range 40-68%). Cerebral vasospasm developed in six patients, but cerebral infarction developed in only three patients. Conclusions. The authors describe the largest cohort with aneurysmal SAH-induced tako-tsubo cardiomyopathy. In the SAH population, tako-tsubo cardiomyopathy predominates in postmenopausal women and is often associated with pulmonary edema, prolonged intubation, and cerebral vasospasm. Additional studies are warranted to understand the complex mechanism involved in tako-tsubo cardiomyopathy and its intriguing relationship to neurogenic stunned myocardium.

AB - Object. Neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage (SAH) is associated with a wide spectrum of reversible left ventricular wall motion abnormalities and includes a subset of patients with a pattern of apical akinesia and concomitant sparing of basal segments called "tako-tsubo cardiomyopathy." Methods. After obtaining institutional review board approval, the authors retrospectively identified among all patients admitted to the Mayo Clinic's Neurological Intensive Care Unit between January 1990 and January 2005 those with aneurysmal SAH who had met the echocardiographic criteria for tako-tsubo cardiomyopathy. Among 24 patients with SAH-induced reversible cardiac dysfunction, the authors identified eight with SAH-induced tako-tsubo cardiomyopathy. All eight patients were women with a mean age of 55.5 years (range 38.6-71.1). Seven patients presented with a poor-grade SAH, reflected by a Hunt and Hess grade of III or IV. Four patients underwent aneurysm clip application, and four underwent endovascular coil occlusion. The initial mean ejection fraction (EF) was 38% (range 25-55%), and the mean EF at recovery was 55% (range 40-68%). Cerebral vasospasm developed in six patients, but cerebral infarction developed in only three patients. Conclusions. The authors describe the largest cohort with aneurysmal SAH-induced tako-tsubo cardiomyopathy. In the SAH population, tako-tsubo cardiomyopathy predominates in postmenopausal women and is often associated with pulmonary edema, prolonged intubation, and cerebral vasospasm. Additional studies are warranted to understand the complex mechanism involved in tako-tsubo cardiomyopathy and its intriguing relationship to neurogenic stunned myocardium.

KW - Cardiac apical ballooning

KW - Neurogenic stunned myocardium

KW - Subarachnoid hemorrhage

KW - Tako-tsubo cardiomyopathy

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