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Age and aneurysm position predict patterns of left ventricular dysfunction after subarachnoid hemorrhage
Kiran Khush1, Alexander Kopelnik, Poyee Tung
1Division of Cardiology, Department of Radiology, University of California-San Francisco Medical Center, 505 Parnassus Avenue, San Francisco, CA 941243, USa.
Summary
Subarachnoid hemorrhage can cause cardiac injury, specifically left ventricular dysfunction. An unusual apex-sparing pattern of cardiac dysfunction may indicate neurally mediated injury in these patients.
Area of Science:
- Cardiology
- Neurology
- Cardiac Imaging
Background:
- Subarachnoid hemorrhage (SAH) frequently leads to cardiac injury, manifesting as left ventricular dysfunction.
- This dysfunction patterns often deviate from typical coronary artery distributions, suggesting a neurogenic origin.
- An apex-sparing pattern of left ventricular dysfunction is particularly uncommon in myocardial infarction, hinting at a distinct injury mechanism.
Purpose of the Study:
- To investigate patterns of left ventricular dysfunction in patients following subarachnoid hemorrhage.
- To differentiate between apex-sparing (AS) and apex-affected (AA) patterns of regional wall-motion abnormalities.
- To identify predictors for the apex-sparing pattern and assess the reversibility of these cardiac abnormalities.
Main Methods:
- Serial echocardiography was conducted on 225 patients diagnosed with subarachnoid hemorrhage.
- Patients with regional wall-motion abnormalities were categorized into either an apex-sparing (AS) or apex-affected (AA) pattern.
- Statistical analysis was performed to identify independent predictors of the AS pattern and evaluate the temporal nature of the wall-motion abnormalities.
Main Results:
- Overall, 27% of patients (61 out of 225) exhibited wall-motion abnormalities.
- The apex-sparing (AS) pattern was observed in 49% of patients with wall-motion abnormalities.
- Younger age and the presence of an anterior aneurysm were identified as independent predictors for the AS pattern.
- Both AS and AA patterns were found to be transient and reversible.
Conclusions:
- Left ventricular dysfunction following subarachnoid hemorrhage can present with distinct patterns, including an apex-sparing variant.
- The apex-sparing pattern, associated with younger patients and anterior aneurysms, may represent a unique form of neurally mediated cardiac injury.
- These cardiac abnormalities are generally reversible, highlighting the dynamic interplay between neurological events and cardiac function.