Cardiac troponin I levels are a marker of myocardial dysfunction in subarachnoid hemorrhage and predicts poor neurologic outcome.

We evaluated the prognostic significance of myocardial dysfunction and associated cardiac troponin I elevation in patients with subarachnoid hemorrhage (SAH). Forty-one patients with no prior cardiac history and who presented with spontaneous SAH were prospectively studied. The LV ejection fraction (LVEF) and regional wall motion by echocardiogram were studied upon admission (Day 0), Day 1 and Day 3 following SAH. Serial troponin I levels, admission Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) were compared in patients with and without LV wall motion abnormality (WMA). Eight patients (20%) had evidence of WMA, of which five (63%) had global hypokinesis and the rest had regional WMA. Patients with WMA had significantly lower LVEF (30% vs 62%, p<0.001) at Day 0, significantly higher troponin I (0.938 vs 0.077, p<0.001) and significantly lower admission GCS (8.2 vs 14.1, p<0.001) compared to those without WMA. LV systolic function improved in 25% of patients by Day 3. Neurologic outcome (GOS) was adversely related to increase in troponin I levels (p=0.04), whereas WMA predicted poor neurologic status (GCS) (P<0.01) and increased hospital stay (P<0.01). Cardiac troponin I levels appear to be a sensitive marker of myocardial dysfunction, which occurred in 20% of patients with SAH, and helps predict poor neurologic outcome.