Clinical characteristics of aneurysmal subarachnoid haemorrhage complicated by Takotsubo cardiomyopathy resulting in good neurological outcome

Abstract

Background

Takotsubo cardiomyopathy (TC) is a well-known complication of subarachnoid haemorrhage (SAH), often accompanied by neurogenic myocardial dysfunction. Although TC has been reported to be associated with higher morbidity and mortality among patients with aneurysmal SAH (aSAH), some patients have been reported to recover, the profiles and follow-up outcomes of these survivors remain unclear.

Materials and Methods

To characterize the profiles of patients with aSAH complicated by TC who experienced favourable outcomes using long-term follow-up data, a consecutive series of patients with aSAH were enrolled and TC diagnosis was based on the revised version of the Mayo Clinic criteria. Clinical outcomes were assessed at 6 months according to modified Rankin Scale scores.

Results

Among 165 consecutive patients with aSAH, 15 cases were complicated by TC, corresponding to an occurrence rate of 9.0%. Five patients with aSAH complicated by TC (33.3%) experienced a favourable outcome, and the mean value of systolic blood pressure on arrival was significantly lower than in those who experienced an unfavourable outcome (p = 0.032).

Conclusion

According to analysis, it is possible cardiac dysfunction with decreased cerebral perfusion pressure and catecholamine toxicity transiently worsens conscious disturbance in aSAH complicated by TC. Therefore, it is important to carefully screen patients with aSAH to identify those complicated by TC, and for close collaboration of the multidisciplinary team to design appropriate treatment strategies.

Keywords:

• Apical ballooning syndrome
• regional wall motion abnormality
• SAH
• Takotsubo cardiomyopathy

Acknowledgment

We thank Dr. Takeru Abe for invaluable advice with clinical statistical analysis. We also would like to thank Editage for English language editing.

Ethical approval

This study protocol was reviewed and approved by the Institutional Review Board, the Ethics Committee of the Yokohama City University Medical Center (approval no. B210400045). The study procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Disclosure statement

The authors report there are no competing interests to declare.

Consent to participate

The Ethics Committee of the Yokohama City University Medical Center also approved that; the requirement for written informed consent was waved; and the individual informed consent was opted out, per the Personal Information Protection Law and National Research Ethics Guideline in Japan.

Additional information

Funding

This article was supported by Grants-in-Aid for Scientific Research (21K09132).