Kilbourn Kent J, Levy Stephanie, Staff Ilene, Kureshi Inam, McCullough Louise
Hartford Hospital, Department of Neurosurgery, Hartford, CT 06102, USA.
Clin Neurol Neurosurg. 2013 Jul;115(7):909-14. doi: 10.1016/j.clineuro.2012.09.006. Epub 2012 Sep 26.
Aneurysmal subarachnoid hemorrhage (aSAH) is an often devastating form of stroke. Aside from the initial hemorrhage, cardiac complications can occur resulting in neurogenic stress cardiomyopathy (NCM), leading to impaired cardiac function. We investigated whether aSAH patients with NCM had poorer long term functional outcomes than patients without NCM. Mortality, vasospasm, and delayed ischemic complications were also evaluated.
A retrospective study of all patients admitted for aneurysmal subarachnoid hemorrhage (aSAH) from January 2006 to June 2011 (n=299) was conducted. Those patients who underwent an echocardiogram were identified (n=120) and were assigned to the NCM (n=49) category based on echocardiographic findings defined by a depressed ejection fraction (EF%) along with a regional wall motion abnormality (RWMA) in a non-vascular pattern. Primary outcome measures included in-hospital mortality and functional outcomes as measured by the Modified Barthel Index (mBI) at 3 months and one year. Secondary analysis determined if there was an association between NCM, cerebral vasospasm and delayed cerebral ischemia.
16% of aSAH patients developed NCM. Mortality was higher (p<.001) in the NCM group (n=23[46.9%]) than in the non-CM group (n=28[11.2%]). Patients with NCM had poorer functional outcomes as measured by the mBI at both 3 months (p=.002) and 12 months (p=.014). The Hunt-Hess score was predictive of functional outcome as measured by the mBI at both 3 months (p=.002) as well as at 1 year (p=.014). NCM was associated with both death (p=.047 CI, 1.012-7.288) and vasospasm (p=.008 CI, 1.34-6.66) after correction for Hunt-Hess grade. Tobacco use (p<.001) and a history of diabetes mellitus (p<.009) were also associated with vasospasm. NCM was associated with higher in-hospital mortality (p=.047) in multivariate analysis.
NCM is seen in a substantial number of aSAH patients and when present, it is associated with higher mortality and poorer long-term functional outcomes. This finding may guide further prospective studies in order to determine if early recognition of NCM as well as optimization of cardiac output would improve mortality.
动脉瘤性蛛网膜下腔出血（aSAH）是一种常具有毁灭性的中风形式。除了初始出血外，还可能发生心脏并发症，导致神经源性应激性心肌病（NCM），进而导致心脏功能受损。我们研究了患有NCM的aSAH患者与未患NCM的患者相比，长期功能预后是否更差。还评估了死亡率、血管痉挛和延迟性缺血并发症。
对2006年1月至2011年6月因动脉瘤性蛛网膜下腔出血（aSAH）入院的所有患者（n = 299）进行回顾性研究。确定那些接受了超声心动图检查的患者（n = 120），并根据超声心动图结果将其分为NCM组（n = 49），该结果定义为射血分数（EF%）降低以及非血管模式的节段性室壁运动异常（RWMA）。主要结局指标包括住院死亡率和功能结局，通过改良Barthel指数（mBI）在3个月和1年时进行测量。二次分析确定NCM、脑血管痉挛和延迟性脑缺血之间是否存在关联。
16%的aSAH患者发生了NCM。NCM组（n = 23[46.9%]）的死亡率高于非NCM组（n = 28[11.2%]）（p <.001）。NCM患者在3个月（p =.002）和12个月（p =.014）时，通过mBI测量的功能结局较差。Hunt-Hess评分在3个月（p =.002）和1年（p =.014）时均是mBI测量的功能结局的预测指标。在校正Hunt-Hess分级后，NCM与死亡（p =.047，CI，1.012 - 7.288）和血管痉挛（p =.008，CI，1.34 - 6.66）均相关。吸烟（p <.001）和糖尿病史（p <.009）也与血管痉挛相关。在多变量分析中，NCM与较高的住院死亡率相关（p =.047）。
大量aSAH患者中可见NCM，当存在NCM时，它与较高的死亡率和较差的长期功能结局相关。这一发现可能指导进一步的前瞻性研究，以确定早期识别NCM以及优化心输出量是否会改善死亡率。
