Cardiac wall motion abnormality after bleeding from vertebral artery aneurysms
Joji Inamasu1, Takuro Hayashi, Motoki Oheda
1Department of Neurosurgery, Fujita Health University Hospital, 1-98 Kutsukake, Toyoake, 470-1192, Japan, namasu@fujita-hu.ac.jp.
Summary
Ruptured vertebral artery aneurysms are linked to a higher incidence of cardiac wall motion abnormality (WMA) in subarachnoid hemorrhage (SAH) patients. This suggests a connection between vertebral artery aneurysms and cardiac dysfunction.
Area of Science:
- Cardiology
- Neurology
- Neurosurgery
Background:
- Cardiac wall motion abnormality (WMA) can occur in patients with subarachnoid hemorrhage (SAH).
- The medulla oblongata's proximity to vertebral artery (VA) aneurysms suggests a potential link to autonomic dysfunction and cardiac issues.
- Previous research has not extensively investigated the relationship between specific aneurysm locations and WMA frequency in SAH.
Purpose of the Study:
- To determine if the frequency of WMA is higher in SAH patients with ruptured vertebral artery (VA) aneurysms compared to those with non-VA aneurysms.
- To explore the correlation between aneurysm location, SAH severity, hydrocephalus, and the occurrence of WMA.
- To investigate the role of plasma catecholamine levels in relation to aneurysm location and WMA.
Main Methods:
- Retrospective analysis of 244 SAH patients who underwent transthoracic echocardiography and plasma catecholamine measurements.
- Comparison of WMA and electrocardiographic (ECG) abnormality frequencies based on aneurysm location (VA vs. non-VA).
- Multivariate regression analysis to identify predictors of WMA, including aneurysm location, SAH grade, and hydrocephalus.
Main Results:
- WMA occurred significantly more often in patients with VA aneurysms (45%) than non-VA aneurysms (22%, p=0.01).
- VA aneurysms (OR 3.3), poor-grade SAH (OR 2.7), and hydrocephalus (OR 3.7) were independently correlated with WMA.
- No significant differences in ECG abnormalities or plasma catecholamine levels were observed between groups.
Conclusions:
- Vertebral artery aneurysms are associated with a disproportionately high frequency of WMA in SAH patients.
- Mechanical stress on the medulla oblongata from VA aneurysm rupture or hydrocephalus may cause transient ischemia, leading to WMA.
- The findings highlight the importance of considering aneurysm location in the management of SAH patients with cardiac complications.
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