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Takotsubo Cardiomyopathy After Subarachnoid Hemorrhage: Who Is At Risk?

Alejandro Pando1, Roger Cheng2, Caryn J Ha3

  • 1Department of Neurological Surgery, Rutgers New Jersey Medical School, Rutgers Robert Wood Johnson Medical School, Newark, NJ, USA.

Journal of Intensive Care Medicine
|January 20, 2025
PubMed
Summary

Takotsubo cardiomyopathy (TCM) following subarachnoid hemorrhage increases mortality and healthcare costs. Key risk factors include female sex, heart failure, and electrolyte disorders, necessitating awareness for improved patient outcomes.

Keywords:
National inpatient sampleTakotsuboheart failurestress cardiomyopathysubarachnoid hemorrhage

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Area of Science:

  • Cardiology
  • Neurology
  • Critical Care Medicine

Background:

  • Takotsubo cardiomyopathy (TCM) is a recognized complication of subarachnoid hemorrhage (SAH), associated with significant morbidity and mortality.
  • Limited data exists on the prevalence and specific risk factors for TCM in non-traumatic SAH.
  • This study aims to identify predictors of TCM in patients with non-traumatic SAH to improve risk stratification and patient management.

Purpose of the Study:

  • To determine the prevalence of Takotsubo cardiomyopathy (TCM) in patients with non-traumatic subarachnoid hemorrhage (SAH).
  • To identify independent risk factors associated with the development of TCM in this patient population.
  • To compare functional outcomes between patients with and without TCM.

Main Methods:

  • Utilized the 2016-2021 National Inpatient Sample (NIS) database to identify adult inpatients with non-traumatic SAH.
  • Performed univariate and multivariable analyses, adjusting for demographics, comorbidities, and hemorrhage etiology.
  • Compared patients with TCM to those without, and further stratified TCM patients by functional outcome (good vs. poor).

Main Results:

  • Out of 42,141 patients with SAH, 486 (1.2%) developed TCM.
  • TCM was associated with increased length of stay, total costs, and mortality (31.7% vs. 22.8%).
  • Independent risk factors for TCM included female sex (OR: 3.11), congestive heart failure (OR: 4.60), and fluid/electrolyte disorders (OR: 2.52).

Conclusions:

  • Takotsubo cardiomyopathy following non-traumatic subarachnoid hemorrhage is linked to worse clinical outcomes, including higher mortality and prolonged hospital stays.
  • Identifying patients with pre-existing conditions like heart failure and electrolyte imbalances is crucial for early detection and management of TCM.
  • Neurocritical care teams should be vigilant for TCM in SAH patients, particularly females, to mitigate associated risks and enhance patient care.