Abstract TP427: Comparison of Clinical Characteristics of Neurogenic Stunned Myocardium in Patients with Subarachnoid Hemorrhage and Acute Ischemic Stroke
Aim: Neurogenic stunned myocardium (NSM) after subarachnoid hemorrhage (SAH) is well known, but there is paucity of data regarding its occurrence following acute ischemic stroke. The aim of this study is to contrast the characteristics of NSM in SAH and acute stroke.
Methods: An electronic literature search was performed with Medline and Google Scholar, for English-language articles using the terms “subarachnoid hemorrhage” along with “stunned myocardium” or “Takotsubo cardiomyopathy”. The search revealed 35 articles, from which 10 studies were selected based on the following criteria: prospective studies, non-traumatic SAH, N >25 patients and documentation of regional wall motion abnormalities (RWMA). For studies from the same institutional database, the one with most comprehensive documentation of cardiac parameters was selected. Another search was conducted using the terms “acute ischemic stroke” along with “stunned myocardium” or “Takotsubo cardiomyopathy” resulted in only 7 case reports/series.
Results: In this descriptive study, 98 out of 504 SAH patients had NSM, evidenced by RWMA (23%). The mean age was 54.8 years and 68% of patients were females, mean Hunt Hess grade was 2.5 and mean LVEF was 55.8%. The mean troponin level was 1.24. The most commonly involved segments were mid-ventricular, basal and apical, in that order. A significant improvement in LVEF occurred in 70.4% of patients. Among stroke patients, the mean age for NSM was 72.5 years and 77% were females. Insular cortex was involved in 46% of cases. Mean troponin elevation was 0.64 and mean LVEF was 34.4%. Regarding outcomes, 84.6% of patients had significant improvement in LVEF, with full recovery in 53.8%.
Conclusion: NSM was more common in females, with favorable prognosis. Mid-ventricular segment was most commonly involved in SAH. The mean troponin was twice higher in SAH, raising the possibility that sympathetic overdrive is stronger in these patients. Only half the patients with NSM following stroke had insular involvement, implying other structures may be involved in the neuro-cardiac axis. Lack of prospective studies in stroke patients, and reports only describing Takotsubo cardiomyopathy, which selectively involves apical segments, are limiting factors.
- © 2012 by American Heart Association, Inc.