Predictors and Outcomes of Stress Cardiomyopathy in Aneurysmal Subarachnoid Hemorrhage
Eileen Yung1, Jeet Metu1, James Devanney1, Omar Alwakaa1, Jean Filo1, Thomas Fodor1, Tzak Ying Lau1, Robert Regenhardt3, Bruno Benitez1, Corey Fehnel1, Jason Yoon1, Magdy Selim1, Philipp Taussky2, Justin Granstein2, Christopher Ogilvy2, Alvin Das1
1Neurocritical Care, 2Neurosurgery, Beth Israel Deaconess Medical Center, 3Neuroendovascular, UTHealth Houston
Objective:
This study aims to identify the risk factors and clinical outcomes, including discharge disability and hospital length of stay (LOS), of stress cardiomyopathy (SCM) after aneurysmal subarachnoid hemorrhage (aSAH).
Background:
Neurogenic stress following aSAH can precipitate SCM, a reversible cardiac syndrome. In the modern era of aSAH care, marked by significant advancements in neuroendovascular treatment for aneurysms, the predictors and impact of SCM on clinical outcomes remain unclear.
Design/Methods:
This single-center retrospective study included consecutive aSAH patients (August 2003 – March 2024). Variables with significant differences in univariable tests between patients with and without SCM, diagnosed using modified Mayo Clinic criteria, were entered into a multivariable logistic regression model to identify predictors of SCM. Multivariable models adjusted for age, sex, Hunt & Hess (HH) scores, baseline modified Rankin Scale (mRS) scores, and vasospasm were used to study the associations between SCM and poor discharge disability (mRS ≥ 3) and LOS.
Results:
Among 374 aSAH patients (mean age 56±14 years, 67% female), 209 (56%) underwent TTE, of which, 15 (7%) were diagnosed with SCM. In the multivariable analysis, female sex (aOR 13.20, 95% CI [1.55–112.43]), vasospasm (aOR 6.98, 95% CI [1.43–33.87], and HH scores (aOR 2.04, 95% CI [1.10–3.80]) were significantly associated with SCM, despite adjustment for acute CSF diversion therapy and admission glucose values.
174 (47%) patients had poor discharge disability, and the mean LOS was 20±12 days. However, SCM was not independently associated with poor discharge disability (aOR 2.15. 95% CI [0.40–11.49]) or longer LOS (β = 3.209, p = 0.53).
Conclusions:
In this contemporary aSAH cohort, female sex, vasospasm, and higher HH scores were significant predictors of SCM development. Although SCM did not impact clinical outcomes, future prospective studies employing a standardized approach to SCM evaluation are needed to fully elucidate its impact on clinical outcomes.
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