Neurocritical Care

, Volume 13, Issue 3, pp 359–365

Left Ventricular Dysfunction and Cerebral Infarction from Vasospasm After Subarachnoid Hemorrhage

  • Richard E. Temes
  • Elena Tessitore
  • J. Michael Schmidt
  • Andrew M. Naidech
  • Andres Fernandez
  • Noeleen D. Ostapkovich
  • Jennifer A. Frontera
  • Katja E. Wartenberg
  • Marco R. Di Tullio
  • Neeraj Badjatia
  • E. Sander Connolly
  • Stephan A. Mayer
  • Augusto Parra
Original Article

DOI: 10.1007/s12028-010-9447-x

Cite this article as:
Temes, R.E., Tessitore, E., Schmidt, J.M. et al. Neurocrit Care (2010) 13: 359. doi:10.1007/s12028-010-9447-x

Abstract

Background

Although neurogenic stunned myocardium (NSM) after aneurysmal subarachnoid hemorrhage (SAH) is well described, its clinical significance remains poorly defined. We investigated the influence of left ventricular (LV) dysfunction and cerebral vasospasm on cerebral infarction, serious cardiovascular events, and functional outcome after SAH.

Methods

Of the 481 patients enrolled in the University Columbia SAH Outcomes Project between 10/96 and 05/02, we analyzed a subset of 119 patients with at least one echocardiogram, serial transcranial Doppler (TCD) data, and with no prior history of cardiac disease. LV dysfunction was defined as an ejection fraction <40% on echocardiography. Infarction from vasospasm was adjudicated by the study team after comprehensive review of all clinical and imaging data. Functional outcome was assessed at 15 and 90 days with the modified Rankin Scale (mRS).

Results

Eleven percent of patients had LV dysfunction (N = 13). Younger age, hydrocephalus, and complete filling of the quadrigeminal and fourth ventricles were associated with LV dysfunction (all P < 0.05). Despite a similar frequency of pre-existing hypertension, 0% of patients with LV dysfunction reported taking antihypertensive medication, compared to 35% of those without (P = 0.009). There was a significant association between LV dysfunction and infarction from vasospasm after adjusting for clinical grade, age, and peak TCD flow velocity (P = 0.03). Patients with LV dysfunction also had higher rates of hypotension requiring vasopressors (P = 0.001) and pulmonary edema (P = 0.002). However, there was no association between LV dysfunction and outcome at 14 days after adjustment for established prognostic variables.

Conclusions

LV dysfunction after SAH increases the risk of cerebral infarction from vasospasm, hypotension, and pulmonary edema, but with aggressive ICU support does not affect short-term survival or functional outcome. Antihypertensive medication may confer cardioprotection and reduce the risk of catecholamine-mediated injury after SAH.

Keywords

Subarachnoid hemorrhageCerebral infarctionVasospasmNeurogenic stunned myocardioumLeft ventricular dysfunctionEchocardiography

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Richard E. Temes
    • 1
    • 5
  • Elena Tessitore
    • 3
  • J. Michael Schmidt
    • 1
  • Andrew M. Naidech
    • 4
  • Andres Fernandez
    • 1
  • Noeleen D. Ostapkovich
    • 1
  • Jennifer A. Frontera
    • 1
    • 6
  • Katja E. Wartenberg
    • 1
    • 7
  • Marco R. Di Tullio
    • 2
  • Neeraj Badjatia
    • 1
  • E. Sander Connolly
    • 1
  • Stephan A. Mayer
    • 1
    • 9
  • Augusto Parra
    • 1
    • 8
    • 10
  1. 1.Neurological Intensive Care UnitColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Division of Medicine, Department of CardiologyColumbia University College of Physicians and SurgeonsNew YorkUSA
  3. 3.Department of Internal MedicineAlbert Einstein College of MedicineBronxUSA
  4. 4.Department of NeurologyNorthwestern University School of MedicineChicagoUSA
  5. 5.Rush University Medical CenterChicagoUSA
  6. 6.Mt Sinai Medical CenterNew YorkUSA
  7. 7.Martin-Luther-Universität Halle-WittenbergHalleGermany
  8. 8.University of TexasSan AntonioUSA
  9. 9.Division of Neurocritical CareNew YorkUSA
  10. 10.Department of NeurosurgerySan AntonioUSA