Abstract 13973: Takotsubo’s Cardiomyopathy is Associated with Severe Subarachnoid Hemorrhage: Retrospective Analysis of 1,251 patients
Background: The relationship between Takotsubo’s cardiomyopathy (TCMP) and severity of subarachnoid hemorrhage (SAH) has not been well described. We hypothesized that patients with severe SAH are more likely to develop TCMP.
Methods: We retrospectively evaluated patients with aneurysmal SAH admitted to the Neurological Intensive Care Unit at a tertiary hospital from January 2004 through December 2009. Patients who had echocardiograms done during hospitalization were identified. TCMP was defined by all four of the following diagnostic criteria: (1) The presence of transient hypokinesis or akinesis in the left ventricular mid and apical segments, or the presence of regional wall motion abnormalities that extend beyond a single epicardial vascular distribution, (2) documentation of resolution of echocardiographic changes (3) new ECG abnormalities (ST-segment elevation or T wave inversion) or elevation of cardiac troponin levels, (4) and changes must not be secondary to coronary artery disease. Severity of SAH was assessed by the Hunt and Hess (H&H) score which ranges from 0 to 5. Fisher’s exact test and logistic regression analysis were used to compare H&H scores of patients with TCMP to those who did not develop cardiomyopathy.
Results: We identified 1,251 patients with aneurysmal SAH. Mean age is 52.8 years. Sixty five percent were women, 52% were white and 30.7% were African American. The mean H&H score was 2.2. Severe SAH (H&H score >=4) was present in 181 (16.2%) patients. Echocardiograms were available for 312 (40.7%) patients. Twelve patients (0.95% of the study population and 2.4 % among those who had echocardiograms) met all the criteria for TCMP. Those were all women and non-African American. High grades SAH (H&H score >=4) were more prevalent in patients who developed TCMP compared to those who did not (41.7% versus 15.9%: P=0.03). The odd ratio of developing TCMP increased by 1.7 (95% CI: 1.1-2.7) for each point increase in the H&H score. Two out of the 12 (18.3%) TCMP patients died during hospitalization; similar to the 16.7% without TCMP (p=0.61).
Conclusion: Severity of aneurysmal subarachnoid hemorrhage as measured by Hunt and Huss score is significantly associated with development of Takotsubo’s cardiomyopathy.
- © 2012 by American Heart Association, Inc.