Abstract 2903: Myocardial Contrast Echocardiography in Subarachnoid Hemorrhage: Brain and Heart Relationship
Background Stroke-related sympathetic surge might be the determinant factor for myocardial stunning seen in patients with cerebrovascular accidents. Real time myocardial contrast echocardiography (MCE) permits simultaneous assessment of function and perfusion. We evaluated the use of MCE in patients with acute- high grade subarachnoid hemorrhage (SAH)
Methods From Jan 2006-May 2007, 10 consecutive patients with high grade SAH and evidence of cardiac dysfunction (enzymatic, wall motion abnormalities (WMA) and-or ECG abnormalities) were enrolled. Standard echocardiography and MCE (Definity®, BMS) were done within 48 hrs of admission. Wall motion score index (WMSI) was evaluated in 16-segment. Qualitative MCE graded as normal =1, abnormal =0. Quantitative MCE parameters were derived from replenishment curves. Followup MCE was done in cases with baseline WMA
Results Mean age 63.5± 10.36 years. WMA were seen in 6 /10(60%) patients on admission [akinesia or hypokinesia in 56/96(58%) segments]. For baseline characteristics see Table⇓. Qualitative MCE perfusion was normal in all patients at baseline and followup despite WMA. Higher baseline quantitative MCE perfusion parameters were observed in patients with WMA compared to those without WMA, however this difference was not significant. Followup MCE was feasible in 3/6 patients with WMA (2 lost followup and 1 death from re-ruptured cerebral aneurysm). Regional systolic function was restored in those who completed followup. Quantitative MCE parameters at followup were not significantly different from baseline; with β 1.3±0.8 vs. 1.3±0.9 and A* β15.6±10.7 vs. 16.3±8.1 respectively
Conclusions MCE could readily evaluate microvascular function in SAH patients. WM and perfusion dissociation was observed. Quantitative MCE confirmed evidence of microvascular hyperemia in abnormal segments. Larger scale studies are needed to explore the pathophysiologic mechanisms underlying neurogenic-stunned myocardium.