Acute Brain Diseases as Triggers for Stress Cardiomyopathy: Clinical Characteristics and Outcomes

• Published in: Neurocritical care 2017-12, Vol.27 (3), p.356-361
• Main Authors: Nasr, Deena M., Tomasini, Sara, Prasad, Abhiram, Rabinstein, Alejandro A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers; Body mass index; Cardiomyopathy; Cardiovascular disease; Convulsions & seizures; Coronary vessels; Critical Care Medicine; Diabetes; Dyspnea; Dyspnea - etiology; Dyspnea - physiopathology; Electrocardiography; Female; Hospitals; Humans; Hypertension; Intensive; Intensive care; Intensive Care Units; Internal Medicine; Intubation; Ischemia; Length of stay; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Original Article; Outcome Assessment (Health Care); Patients; Statistical analysis; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - physiopathology; Takotsubo Cardiomyopathy - etiology; Takotsubo Cardiomyopathy - physiopathology; Vein & artery diseases
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-017-0412-9

Objective To determine the clinical characteristics and outcomes of patients with neurogenic stress cardiomyopathy (NSC) among patients admitted to our neuroscience intensive care unit (NICU). Methods Following institutional review board approval, consecutive adult patients admitted to the NICU between 2009 and 2013 with definite and possible NSC were included. Data on patient demographics, baseline clinical information, cardiac function, and laboratory values were collected. Outcomes included length of stay, modified Rankin Scale (mRS) at discharge and long-term follow-up. Continuous variables were compared using a student’s t test, and categorical variables were compared using a Chi-square test. Results Among 34 patients included in the study, the most common presenting symptom was dyspnea (17 patients, 50%). Subarachnoid hemorrhage (SAH) was the most common neurological inciting event (11 patients, 32.4%), but two-thirds of this cohort had other neurological triggers. The most common electrocardiogram changes were QT-interval prolongation (30 patients, 88.2%) and T-wave inversion (22 patients, 64.7%). The most common echocardiographic pattern was the apical variant (14 patients, 41.2%), and 26% of patients had right ventricular involvement ( P  = 0.03) which was a predictor of poor outcome along with inotropic support ( P  = 0.006). Functional outcome was poor (mRS > 3) in 53% of patients at discharge, but function improved over time in most survivors. Conclusions NSC is most common after SAH, but can result from a wide spectrum of acute brain insults. Requirement of inotropic support was the strongest indicator of prognosis at last follow-up. Patients with NSC often have poor function at discharge but many improve over time.