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(Stroke. 2000;31:1136.)
© 2000 American Heart Association, Inc.

Original Contributions

Regional Myocardial Perfusion After Experimental Subarachnoid Hemorrhage

Jonathan G. Zaroff, MD; Guy A. Rordorf, MD; James S. Titus; John B. Newell, BA; Nicholas J. Nowak, BA; David F. Torchiana, MD; H. Thomas Aretz, MD Michael H. Picard, MD

From the Cardiac (J.G.Z., J.B.N., N.J.N., M.H.P.), Cardiac Surgery (J.S.T., D.F.T.), Neurology (G.A.R.), and Pathology (H.T.A.) Units, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.

Correspondence to Michael H. Picard, MD, Cardiac Ultrasound Laboratory, VBK-508, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. E-mail mhpicard{at}partners.org

Background and Purpose—The pathophysiology of cardiac injury after subarachnoid hemorrhage (SAH) remains controversial. Data from animal models suggest that catecholamine-mediated injury is the most likely cause of cardiac injury after SAH. However, researchers also have proposed myocardial ischemia to be the underlying cause, as a result of coronary artery disease, coronary artery spasm, or hypertension and tachycardia. To test the hypothesis that SAH-induced cardiac injury occurs in the absence of myocardial hypoperfusion, we developed an experimental canine model that reproduces the clinical and pathological cardiac lesions of SAH and defines the epicardial and microvascular coronary circulation.

Methods—Serial ECG, hemodynamic measurements, coronary angiography, regional myocardial blood flow measurements by radiolabeled microspheres, 2D echocardiography, and myocardial contrast echocardiography were performed in 9 dogs with experimental SAH and 5 controls.

Results—Regional wall motion abnormalities were identified in 8 of 9 SAH dogs and 1 of 5 controls (Fisher’s Exact Test, P=0.02) but no evidence was seen of coronary artery disease or spasm by coronary angiography and of significant myocardial hypoperfusion by either regional myocardial blood flow or myocardial contrast echocardiography.

Conclusions—In this experimental model of SAH, a unique form of regional left ventricular dysfunction occurs in the absence of myocardial hypoperfusion. Future studies are justified to determine the cause of cardiac injury after SAH.

Editorial Comment

R. Loch Macdonald, MD, Guest Editor

Section of Neurosurgery, University of Chicago Medical Center, Chicago, Illinois

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