Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage

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Object

Subarachnoid hemorrhage (SAH) has been associated with cardiac injury and left ventricular (LV) dysfunction. The incidence and natural history of neurocardiogenic injury after SAH remains poorly understood. The objective of this study was to describe the incidence, time course, recovery rate, and segmental patterns of LV dysfunction after SAH.

Methods

Echocardiography was performed three times over a 7-day period in 173 patients with SAH. The incidence of global (ejection fraction [EF] < 50%) and segmental (any regional wall-motion abnormality [RWMA]) LV dysfunction was measured. The time course of LV dysfunction was determined by comparing the prevalence of LVEF less than 50% and RWMA at 0 to 2, 3 to 5, and 6 to 8 days after SAH. The recovery rate was defined as the proportion of patients with partial or complete normalization of function. The distribution of RWMAs among 16 LV segments was also determined. An LVEF less than 50% was found in 15% of patients, and 13% had an RWMA with a normal LVEF. There was a trend toward increased dysfunction at 0 to 2 days after SAH, compared with 3 to 8 days after SAH. Recovery of LV function was observed in 66% of patients. The most frequently abnormal LV segments were the basal and middle ventricular portions of the anteroseptal and anterior walls. The apex was rarely affected.

Conclusions

Left ventricular systolic dysfunction occurs frequently after SAH and usually improves over time. The observed segmental patterns of LV dysfunction often do not correlate with coronary artery distributions.

Abbreviations used in this paper:CI = confidence interval; cTnI = cardiac troponin I; ECG = electrocardiographic; EF = ejection fraction; LV = left ventricular; LVEF = LV ejection fraction; OR = odds ratio; RWMA = regional wall-motion abnormality; RWMS = RWM score; SAH = subarachnoid hemorrhage.

Article Information

Address reprint requests to: Jonathan Zaroff, M.D., 505 Parnassus Avenue, Moffitt Suite 1177, San Francisco, California 94117-0124. email: zaroff@medicine.ucsf.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Bar graph depicting the distribution of LVEFs (%) observed in 489 echocardiograms obtained in 173 patients with SAH.

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    Graph depicting the prevalence of an abnormally elevated (> 1) RWMS (diamonds) and an abnormally reduced (< 50%) LVEF (squares) for three time periods after the onset of symptoms of SAH.

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    Graph depicting change in RWMS for 44 patients who underwent follow-up echocardiography after an abnormal echocardiogram. Improvement (decline in RWMS) was observed in 29 patients, and failure to improve or worsening (increase in RWMS) was observed in 15 patients. The mean follow-up RWMS was significantly lower than the mean initial RWMS (1.30 ± 0.36 compared with 1.46 ± 0.45, respectively; p = 0.013, Wilcoxon signed-rank test).

  • View in gallery

    Diagram depicting the prevalence of RWMAs for each of the 16 LV segments. The outer circle represents the six basal segments of the left ventricle, the middle circle represents the six middle ventricular segments, and the inner circle represents the four apical segments. Black shading indicates a 51 to 75% prevalence of RWMA, gray indicates a 25 to 50% prevalence, and white indicates a prevalence of less than 25%. AL = anterolateral; AN = anterior; AS = anteroseptal; IN = inferior; IS = inferoseptal; PL = posterolateral.

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