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Kawasaki T, Nakamura T, Ohtake M, Akimoto T, Manaka H, Hamada K, Sakata K, Iwashita M, Takeuchi I, Yamamoto T. Clinical characteristics of aneurysmal subarachnoid haemorrhage complicated by Takotsubo cardiomyopathy resulting in good neurological outcome. Br J Neurosurg 2024:1-8. [PMID: 38571386 DOI: 10.1080/02688697.2024.2334432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is a well-known complication of subarachnoid haemorrhage (SAH), often accompanied by neurogenic myocardial dysfunction. Although TC has been reported to be associated with higher morbidity and mortality among patients with aneurysmal SAH (aSAH), some patients have been reported to recover, the profiles and follow-up outcomes of these survivors remain unclear. MATERIALS AND METHODS To characterize the profiles of patients with aSAH complicated by TC who experienced favourable outcomes using long-term follow-up data, a consecutive series of patients with aSAH were enrolled and TC diagnosis was based on the revised version of the Mayo Clinic criteria. Clinical outcomes were assessed at 6 months according to modified Rankin Scale scores. RESULTS Among 165 consecutive patients with aSAH, 15 cases were complicated by TC, corresponding to an occurrence rate of 9.0%. Five patients with aSAH complicated by TC (33.3%) experienced a favourable outcome, and the mean value of systolic blood pressure on arrival was significantly lower than in those who experienced an unfavourable outcome (p = 0.032). CONCLUSION According to analysis, it is possible cardiac dysfunction with decreased cerebral perfusion pressure and catecholamine toxicity transiently worsens conscious disturbance in aSAH complicated by TC. Therefore, it is important to carefully screen patients with aSAH to identify those complicated by TC, and for close collaboration of the multidisciplinary team to design appropriate treatment strategies.
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Affiliation(s)
- Takafumi Kawasaki
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Ohtake
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Taisuke Akimoto
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Manaka
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Koichi Hamada
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsumi Sakata
- Department of Neurosurgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Masayuki Iwashita
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Ichiro Takeuchi
- Department of Emergency and Critical Care, Yokohama City University Medical Center, Yokohama, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Pi S, Liu Y, Li T, Peng W, Wang D, Huang L, Kang N. Added value of contrast echocardiography in characterization of nonischemic cardiomyopathy. J Int Med Res 2018; 46:4813-4820. [PMID: 30213225 PMCID: PMC6259393 DOI: 10.1177/0300060518798525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Nonischemic cardiomyopathy (NICM) is a group of noncoronary heterogonous myocardial diseases. The heterogonous nature of NICM has impeded its diagnosis. In the present case series, we demonstrate the added value of using contrast echocardiography in the characterization of NICM. Two patients of advanced age were admitted for possible acute coronary syndrome, which was subsequently excluded by coronary angiography. Conventional and contrast echocardiography revealed characteristic structural and dynamic features of the left ventricle that were compatible with two distinct NICM diseases: stress-induced cardiomyopathy and noncompaction of the ventricular myocardium. Contrast echocardiography characterizes the cardiac structure and allows for real-time assessment of myocardial motion and perfusion. It may help to distinguish diseases with different etiologies.
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Affiliation(s)
- Shufang Pi
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Yingwu Liu
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Tong Li
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Wenjin Peng
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Dong Wang
- 2 Department of Ultrasonography, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Lei Huang
- 1 Heart Center, Third Central Hospital of Tianjin, Tianjin, China.,3 Tianjin Institute of Hepatobiliary Disease, Tianjin, China.,4 Tianjin Key Laboratory of Artificial Cell, Tianjin, China.,5 Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China
| | - Ningdong Kang
- 6 The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
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Long-Term Outcomes for Different Forms of Stress Cardiomyopathy After Surgical Treatment for Subarachnoid Hemorrhage. Anesth Analg 2016; 122:1594-602. [PMID: 27007075 DOI: 10.1213/ane.0000000000001231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Stress-induced cardiomyopathy (SCM) after subarachnoid hemorrhage (SAH) includes predominant apical or basal regional left ventricular dysfunction (RLVD) with concomitant changes in electrocardiogram or increase in cardiac enzymes. We hypothesized that difference in outcome is associated with the type of RLVD after SAH. METHODS We studied a single-center retrospective cohort of SAH patients hospitalized between 2000 and 2010 with follow-up until 2013. We classified patients who had an echocardiogram for clinically indicated reasons according to the predominate location of RLVD as classic SCM-apical form and variant SCM-basal form. A Cox proportional hazard model and logistic regression were used to estimate the risk for death and hospital complications associated with different RLVD after adjustment for propensity to undergo echocardiography given clinical characteristics on admission. RESULTS Among 715 SAH patients, 28% (200/715) had an echocardiogram for clinical evidence of cardiac dysfunction during hospitalization, the most common being acute left ventricular dysfunction, suspected acute ischemic event, changes in electrocardiogram and cardiac enzymes, and arrhythmia. SCM was present in 59 patients (8% of all cohort and 30% of patients with echocardiogram, respectively) with similar distribution of SCM-basal (25/59) and SCM-apical forms (34/59). SAH patients who had an echocardiogram for clinically indicated reasons had a significantly decreased risk-adjusted long-term survival compared with those without an echocardiogram, regardless of the presence of RLVD. SCM-basal form was associated with cardiac complications (odds ratio, 6.1; 99% confidence interval, 1.8-20.2) and severe sepsis (odds ratio, 5.3; 99% confidence interval, 1.6-17.2). CONCLUSIONS SAH patients with echocardiogram for a clinically indicated reason have a decreased long-term survival, regardless of the presence of RLVD. The association between severe sepsis and SCM-basal warrants future studies to determine their potential synergistic effect on left ventricular systolic dysfunction among SAH patients.
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Finsterer J, Bersano A. Subarachnoid bleeding triggering Takotsubo syndrome. Int J Cardiol 2015; 197:107-9. [DOI: 10.1016/j.ijcard.2015.06.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/16/2015] [Indexed: 02/08/2023]
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Finsterer J, Wahbi K. CNS disease triggering Takotsubo stress cardiomyopathy. Int J Cardiol 2014; 177:322-9. [PMID: 25213573 DOI: 10.1016/j.ijcard.2014.08.101] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/17/2014] [Indexed: 01/23/2023]
Abstract
There are a number of hereditary and non-hereditary central nervous system (CNS) disorders, which directly or indirectly affect the heart (brain-heart disorders). The most well-known of these CNS disorders are epilepsy, stroke, infectious or immunological encephalitis/meningitis, migraine, and traumatic brain injury. In addition, a number of hereditary and non-hereditary neurodegenerative disorders may impair cardiac functions. Affection of the heart may manifest not only as arrhythmias, myocardial infarction, autonomic impairment, systolic dysfunction/heart failure, arterial hypertension, or pulmonary hypertension, but also as stress cardiomyopathy (Takotsubo syndrome, TTS). CNS disease triggering TTS includes subarachnoid bleeding, epilepsy, ischemic stroke, intracerebral bleeding, migraine, encephalitis, traumatic brain injury, PRES syndrome, or ALS. Usually, TTS is acutely precipitated by stress triggered by various different events. TTS is one of the cardiac abnormalities most frequently induced by CNS disorders. Appropriate management of TTS from CNS disorders is essential to improve the outcome of affected patients.
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Affiliation(s)
| | - Karim Wahbi
- Paris-Descartes, Sorbonne Paris Cite University, 75006 Paris, France; AP-HP, Cardiology Department, Cochin Hospital, Paris, France; AP-HP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
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Stress cardiomyopathy (tako-tsubo) triggered by nervous system diseases: A systematic review of the reported cases. Int J Cardiol 2013; 167:2441-8. [DOI: 10.1016/j.ijcard.2013.01.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/19/2012] [Accepted: 01/18/2013] [Indexed: 01/09/2023]
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Cardiomyopathy in neurological disorders. Cardiovasc Pathol 2013; 22:389-400. [PMID: 23433859 DOI: 10.1016/j.carpath.2012.12.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 12/26/2012] [Accepted: 12/30/2012] [Indexed: 12/13/2022] Open
Abstract
According to the American Heart Association, cardiomyopathies are classified as primary (solely or predominantly confined to heart muscle), secondary (those showing pathological myocardial involvement as part of a neuromuscular disorder) and those in which cardiomyopathy is the first/predominant manifestation of a neuromuscular disorder. Cardiomyopathies may be further classified as hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, or unclassified cardiomyopathy (noncompaction, Takotsubo-cardiomyopathy). This review focuses on secondary cardiomyopathies and those in which cardiomyopathy is the predominant manifestation of a myopathy. Any of them may cause neurological disease, and any of them may be a manifestation of a neurological disorder. Neurological disease most frequently caused by cardiomyopathies is ischemic stroke, followed by transitory ischemic attack, syncope, or vertigo. Neurological disease, which most frequently manifests with cardiomyopathies are the neuromuscular disorders. Most commonly associated with cardiomyopathies are muscular dystrophies, myofibrillar myopathies, congenital myopathies and metabolic myopathies. Management of neurological disease caused by cardiomyopathies is not at variance from the same neurological disorders due to other causes. Management of secondary cardiomyopathies is not different from that of cardiomyopathies due to other causes either. Patients with neuromuscular disorders require early cardiologic investigations and close follow-ups, patients with cardiomyopathies require neurological investigation and avoidance of muscle toxic medication if a neuromuscular disorder is diagnosed. Which patients with cardiomyopathy profit most from primary stroke prevention is unsolved and requires further investigations.
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Spadotto V, Elmaghawry M, Zorzi A, Migliore F, Marra MP. Apical ballooning with mid-ventricular obstruction: the many faces of Takotsubo cardiomyopathy. Glob Cardiol Sci Pract 2013; 2013:163-8. [PMID: 24689016 PMCID: PMC3963740 DOI: 10.5339/gcsp.2013.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/14/2013] [Indexed: 01/14/2023] Open
Abstract
Takotsubo cardiomyopathy (TTC) is a transient left ventricular dysfunction due to akinesia of the left-ventricular (LV) mid-apical segments (apical ballooning), which can cause severe reduction in LV systolic function. The typical clinical picture of TTC include chest pain, electrocardiographic changes consisting of mild ST-segment elevation followed by diffuse deep T-wave inversion, QTc interval prolongation and mild troponin release in the absence of significant coronary stenoses. The syndrome often affects post-menopausal women and is triggered by sympathetic overstimulation, like intense physical or emotional stress, so that it is called the "broken heart syndrome". Although left-ventricular systolic dysfunction usually fully recovers within few days, heart failure can still complicate the early phase. We report a case of stress-induced cardiomyopathy that had full recovery after 4 weeks of follow up. The main electrocardiographic, angiographic and imaging features are discussed.
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Affiliation(s)
- Veronica Spadotto
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Alessandro Zorzi
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Martina Perazzolo Marra
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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