Association Between Acute Neurological Diseases and Stress-induced Cardiomyopathy: A Systematic Review and Meta-Analysis of Observational Studies
Bishal Dhakal1, Qurat Ul Ain Muhammad2, Aashish Baniya3, Rojina Pokharel4, Prabin Basnet5, Ram Subedi6, Sagun Dawadi1, Kushal Shrestha1, Raju Paudel6
1Nepalese Army Institute of Health Sciences, 2Rawalpindi Medical University, 3Suny Downstate, 4Sahid Memorial Hospital, 5Kathmandu University School of Medical Sciences, 6Grande International Hospital
Objective:

To explore the bidirectional association between acute neurological disorders and stress-induced cardiomyopathy.

Background:

There is evidence suggesting a possible association between acute neurological disorders and stress-induced cardiomyopathy. However, the prevalence and phenotype of acute neurological diseases in patients with stress-induced cardiomyopathy and vice versa are yet to be explored. 

Design/Methods:

A comprehensive search was conducted for relevant studies across multiple electronic databases, including PubMed, Embase, Scopus, CINAHL, Cochrane, and clinical trial registries. Meta-analysis was performed using Comprehensive Meta-Analysis software, version 3.

Results:

The quantitative synthesis comprised 52 studies with 14,946,297 individuals. The pooled mean age for the Takotsubo population was 61.46±14.63 years. Pooled analysis revealed that Takotsubo cardiomyopathy (TCM) was observed in 6.3% [proportion, 0.063; 95% confidence interval (CI), 0.030-0.128, I2=98.88] of the population with subarachnoid hemorrhage (SAH), 0.5% (proportion, 0.005; 95% CI, 0.001-0.030, I2=96.29) with seizures, and 0.3% (proportion, 0.003; 95% CI, 0.0004-0.021, I2=98.87) with ischemic stroke/transient ischemic attack (TIA). Likewise, neurogenic stress cardiomyopathy (NCM) occurred in 15.9% (proportion, 0.159; 95% CI, 0.135-0.186, I2=28.17) of the population with SAH. Conversely, 2.5% (proportion, 0.025; 95% CI, 0.021-0.030, I2=85.85) and 1.8% (proportion, 0.018; 95% CI, 0.018-0.019, I2=0) of the population with TCM experienced ischemic stroke/TIA and migraine headaches as a consequence, respectively. The pooled analysis also depicted that TCM was associated as an outcome with traumatic brain injury (9%, 9/100), intracranial hemorrhage (0.26%, 234/88677), and status epilepticus (56.25%, 18/32). The pooled data from three studies showed higher odds of ischemic stroke/TIA (OR, 4.39; 95% CI, 1.52-12.70, I2=90%) in patients with TCM.

Conclusions:

This review represents the largest to-date synthesis of evidence on the association between stress-induced cardiomyopathy and acute neurological diseases. We conclude that TCM and NCM are highly prevalent in patients with SAH. Additionally, ischemic stroke/TIA and migraine are notable consequences in patients with TCM. 

10.1212/WNL.0000000000211739
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.