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Speckle tracking analysis allows sensitive detection of stress cardiomyopathy in severe aneurysmal subarachnoid hemorrhage patients

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Abstract

Purpose

Stress cardiomyopathy is a common life-threatening complication after aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that left ventricular (LV) longitudinal strain alterations assessed with speckle tracking could identify early systolic function impairment.

Methods

This was an observational single-center prospective pilot controlled study conducted in a neuro-intensive care unit. Forty-six patients with severe SAH with a World Federation of Neurological Surgeons grade (WFNS) ≥III were included. Transthoracic echocardiography (TTE) was performed on day 1, day 3, and day 7 after the patient’s admission. A cardiologist blinded to the patient’s management analyzed the LV global longitudinal strain (GLS). The control group comprised normal subjects matched according to gender and age.

Results

On day 1 median (25th–75th percentile) GLS was clearly impaired in SAH patients compared to controls [−16.7 (−18.7/−13.7) % versus −20 (−22/−19) %, p < 0.0001], whereas LVEF was preserved [65 (59−70) %]. GLS was severely impaired in patients with a WFNS score of V versus III–IV [−15.6 (−16.9/−12.3) % versus −17.8 (−20.6/−15.8) %, p = 0.008]. Seventeen (37 %) patients had a severe GLS alteration (>−16 %). In these patients, GLS improved from day 1 [−12.4 (−14.8/−10.9) %] to last evaluation [−16.2 (−19/−14.6) %, p = 0.0007] in agreement with the natural evolution of stress cardiomyopathy.

Conclusions

On the basis of LV GLS assessment, we demonstrated for the first time that myocardial alteration compatible with a stress cardiomyopathy is detectable in up to 37 % of patients with severe SAH while LVEF is preserved. GLS could be used for sensitive detection of stress cardiomyopathy. This is critical because cardiac impairment remains a major cause of morbidity and mortality after SAH.

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Acknowledgments

This study was supported in part by a grant from the Clinical Research Hospital Program (PHRC) of the French Ministry of Health (PHRC-I RC12-0143 in 2012), and a grant from the Fédération Française de Cardiologie (no R11065NN–RAK11093NNA in 2012). T. le Tourneau was supported by INSERM (INSERM Translational Research Grant 2012–2016).

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    Authors and Affiliations

    1. Department of Anesthesiology and Critical Care Medicine, Hôtel Dieu, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes cedex, France

      Raphaël Cinotti, Adrien Delater & Karim Asehnoune

    2. Department of Cardiology and Vascular Diseases, Hospital Guillaume et René Laennec, CHU de Nantes, Boulevard Jacques Monod, 44800, Saint-Herblain, France

      Nicolas Piriou, Maxime Lamer & Jean-Noël Trochu

    3. Department of Anesthesiology and Critical Care Medicine, Hôpital Pontchaillou, CHU de Rennes, 2 avenue Henri le Guilloux, 35000, Rennes, France

      Yoann Launey, Philippe Seguin & Yannick Mallédant

    4. Department of Explorations fonctionnelles, Hôtel Dieu, CHU de Nantes, 1 Place Alexis Ricordeau, 44093, Nantes cedex, France

      Thierry Le Tourneau

    5. Department of Anesthesiology and Critical Care Medicine, Hospital Guillaume and René Laennec, CHU de Nantes, Boulevard Jaques Monod, 44800, Saint-Herblain, France

      Laurent Brisard, Karim Lakhal, Yvonnick Blanloeil & Bertrand Rozec

    6. Department of Neuroradiology, Hospital Guillaume et René Laennec, CHU de Nantes, Boulevard Jacques Monod, 44800, Saint-Herblain, France

      Romain Bourcier & Hubert Desal

    7. EA 4275 “Biostatistique, pharmaco-épidémiologie et mesures subjectives en santé”, Faculté de Pharmacie, Université de Nantes, 1 rue Gaston Veil, 44035, Nantes Cedex 1, France

      Fanny Feuillet

    8. Plateforme de Biométrie, Cellule de Promotion de la recherche clinique, 1 rue Gaston Veil, 44035, Nantes Cedex 1, France

      Fanny Feuillet

    9. Laboratoire UPRES EA 3826 “Thérapeutiques cliniques et expérimentales des infections”, Faculté de médecine, Université de Nantes, Nantes, France

      Karim Asehnoune

    10. Institut du thorax, INSERM UMR1087, IRT UN, 8 quai Moncousu, BP 7072, 44007, Nantes Cedex 1, France

      Bertrand Rozec

    Authors
    1. Raphaël Cinotti
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    Correspondence to Karim Asehnoune.

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    The authors have no conflict of interest to declare about this work.

    Additional information

    R. Cinotti, N. Piriou, K. Asehnoune, and B. Rozec should be considered as having equal participation in this study.

    Take-home message: In severe subarachnoid hemorrhage, speckle tracking evaluation of left ventricle longitudinal function demonstrates the frequent alteration of longitudinal systolic function suggestive of stress cardiomyopathy. In this setting longitudinal function assessment might allow diagnosis of a systolic dysfunction while the classical left ventricular ejection fraction appears preserved.

    On behalf of the ATLANRÉA study group.

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    Cinotti, R., Piriou, N., Launey, Y. et al. Speckle tracking analysis allows sensitive detection of stress cardiomyopathy in severe aneurysmal subarachnoid hemorrhage patients. Intensive Care Med 42, 173–182 (2016). https://doi.org/10.1007/s00134-015-4106-5

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