Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium

Osaka Mishima Critical Care Medical Center, Japan.

OBJECTIVES. The purpose of this study was to determine whether a relation exists between electrocardiographic (ECG) abnormalities and left ventricular wall motion in patients with subarachnoid hemorrhage. BACKGROUND. Although ECG changes simulating acute myocardial infarction are frequently seen in patients with subarachnoid hemorrhage, their relation to left ventricular wall motion has not been established. METHODS. Twelve patients with subarachnoid hemorrhage were classified according to the presence of ST segment elevation in at least two consecutive leads on admission: seven patients with ST segment elevation (group I) and five patients without ST segment elevation (group II). No patients had a previous history of heart disease. Left ventricular regional wall motion was evaluated by the centerline method. The mean (+/- SEM) duration from onset of subarachnoid hemorrhage to left ventriculography was 9 +/- 3 h in group I and 10 +/- 1 h in group II. Coronary angiography was performed to rule out wall motion abnormalities due to coronary artery disease while the ST segment was still elevated. Two-dimensional echocardiography was used to evaluate wall motion thereafter. RESULTS. All patients in group I showed ST segment elevation in ECG leads V4 to V6. Wall motion of the left ventricular apex was significantly reduced in group I compared with group II (-2.48 +/- 0.41 vs. -0.45 +/- 0.72, p < 0.02). No patients showed organic stenosis or vasospasm, or both, of epicardial coronary arteries. Wall motion abnormalities decreased echocardiographically in all patients, but one patient in group I died in hospital at 2 or 3 weeks after the onset of subarachnoid hemorrhage, when the T wave was inverted in leads V4 to V6. CONCLUSIONS. These findings suggest that patients with subarachnoid hemorrhage and ST segment elevation may demonstrate transient corresponding regional wall motion abnormalities. The mechanism of neurogenic stunned myocardium was not clearly elucidated in the present study.

This article has been cited by other articles:

				K. A. Bybee and A. Prasad Stress-Related Cardiomyopathy Syndromes Circulation, July 22, 2008; 118(4): 397 - 409. [Full Text] [PDF]

				N. Frey, H. A. Katus, and E. Giannitsis The Tako-Tsubo Syndrome: An Underappreciated, Novel Disease Entity Chest, September 1, 2007; 132(3): 743 - 744. [Full Text] [PDF]

				H.-J. Priebe Aneurysmal subarachnoid haemorrhage and the anaesthetist Br. J. Anaesth., July 1, 2007; 99(1): 102 - 118. [Abstract] [Full Text] [PDF]

				E. A. Hessel II The brain and the heart. Anesth. Analg., September 1, 2006; 103(3): 522 - 526. [Full Text] [PDF]

				D. J. Kutsogiannis, G. Pagliarello, C. Doig, H. Ross, and S. D. Shemie Medical management to optimize donor organ potential: review of the literature: [Traitement medical pour optimaliser le potentiel de don d'organe : une revue documentaire]. Can J Anesth, August 1, 2006; 53(8): 820 - 830. [Abstract] [Full Text] [PDF]

				A. M. Naidech Adrenoreceptor Polymorphisms and Subarachnoid Hemorrhage Stroke, July 1, 2006; 37(7): 1635 - 1635. [Full Text] [PDF]

				D Haghi, T Papavassiliu, S Fluchter, J J Kaden, T Porner, M Borggrefe, and T Suselbeck Variant form of the acute apical ballooning syndrome (takotsubo cardiomyopathy): observations on a novel entity. Heart, March 1, 2006; 92(3): 392 - 394. [Full Text] [PDF]

				S. Laowattana, S. L. Zeger, J.A.C. Lima, S. N. Goodman, I. S. Wittstein, and S. M. Oppenheimer Left insular stroke is associated with adverse cardiac outcome Neurology, February 28, 2006; 66(4): 477 - 483. [Abstract] [Full Text] [PDF]

				N. M. Banki, A. Kopelnik, M. W. Dae, J. Miss, P. Tung, M. T. Lawton, B. J. Drew, E. Foster, W. Smith, W. W. Parmley, et al. Acute Neurocardiogenic Injury After Subarachnoid Hemorrhage Circulation, November 22, 2005; 112(21): 3314 - 3319. [Abstract] [Full Text] [PDF]

				A. M. Naidech, K. T. Kreiter, N. Janjua, N. D. Ostapkovich, A. Parra, C. Commichau, B.-F. M. Fitzsimmons, E. S. Connolly, and S. A. Mayer Cardiac Troponin Elevation, Cardiovascular Morbidity, and Outcome After Subarachnoid Hemorrhage Circulation, November 1, 2005; 112(18): 2851 - 2856. [Abstract] [Full Text] [PDF]

				J. Ako, Y. Honda, and P. J. Fitzgerald Transient Left Ventricular Apical Ballooning Ann Intern Med, April 19, 2005; 142(8): 678 - 678. [Full Text] [PDF]

				I. de Chazal, W. M. Parham III, P. Liopyris, and E. F. M. Wijdicks Delayed Cardiogenic Shock and Acute Lung Injury After Aneurysmal Subarachnoid Hemorrhage Anesth. Analg., April 1, 2005; 100(4): 1147 - 1149. [Abstract] [Full Text] [PDF]

				I. S. Wittstein, D. R. Thiemann, J. A.C. Lima, K. L. Baughman, S. P. Schulman, G. Gerstenblith, K. C. Wu, J. J. Rade, T. J. Bivalacqua, and H. C. Champion Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress N. Engl. J. Med., February 10, 2005; 352(6): 539 - 548. [Abstract] [Full Text] [PDF]

				G. W. Dec Recognition of the Apical Ballooning Syndrome in the United States Circulation, February 1, 2005; 111(4): 388 - 390. [Full Text] [PDF]

				S. W. Sharkey, J. R. Lesser, A. G. Zenovich, M. S. Maron, J. Lindberg, T. F. Longe, and B. J. Maron Acute and Reversible Cardiomyopathy Provoked by Stress in Women From the United States Circulation, February 1, 2005; 111(4): 472 - 479. [Abstract] [Full Text] [PDF]

				K. A. Bybee, T. Kara, A. Prasad, A. Lerman, G. W. Barsness, R. S. Wright, and C. S. Rihal Systematic Review: Transient Left Ventricular Apical Ballooning: A Syndrome That Mimics ST-Segment Elevation Myocardial Infarction Ann Intern Med, December 7, 2004; 141(11): 858 - 865. [Abstract] [Full Text] [PDF]

				C. Van Mieghem, M. Sabbe, and D. Knockaert The Clinical Value of the ECG in Noncardiac Conditions Chest, April 1, 2004; 125(4): 1561 - 1576. [Abstract] [Full Text] [PDF]

				P. Tung, A. Kopelnik, N. Banki, K. Ong, N. Ko, M. T. Lawton, D. Gress, B. Drew, E. Foster, W. Parmley, et al. Predictors of Neurocardiogenic Injury After Subarachnoid Hemorrhage Stroke, February 1, 2004; 35(2): 548 - 551. [Abstract] [Full Text] [PDF]

				J. Ako, Y. Honda, P. J. Fitzgerald, J. P. Girod, A. W. Messerli, F. Zidar, W.H. W. Tang, and S. J. Brener Tako-Tsubo-Like Left Ventricular Dysfunction * Response Circulation, December 9, 2003; 108 (23): e158 - e158. [Full Text] [PDF]

				Y. Abe Transient left ventricular apical ballooning and outflow tract obstruction: Reply J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1144 - 1144. [Full Text] [PDF]

				Y Abe and M Kondo Apical ballooning of the left ventricle: a distinct entity? Heart, September 1, 2003; 89(9): 974 - 976. [Full Text] [PDF]

				D. Arab, A. M. Yahia, and A. I. Qureshi Cardiovascular Manifestations of Acute Intracranial Lesions: Pathophysiology, Manifestations, and Treatment J Intensive Care Med, May 1, 2003; 18(3): 119 - 129. [Abstract] [PDF]

				Y. Abe, M. Kondo, R. Matsuoka, M. Araki, K. Dohyama, and H. Tanio Assessment of clinical features in transient left ventricular apical ballooning J. Am. Coll. Cardiol., March 5, 2003; 41(5): 737 - 742. [Abstract] [Full Text] [PDF]

				C. E. Sommargren Electrocardiographic Abnormalities in Patients With Subarachnoid Hemorrhage Am. J. Crit. Care., January 1, 2002; 11(1): 48 - 56. [Abstract] [Full Text] [PDF]

				K. Tsuchihashi, K. Ueshima, T. Uchida, N. Oh-mura, K. Kimura, M. Owa, M. Yoshiyama, S. Miyazaki, K. Haze, H. Ogawa, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction J. Am. Coll. Cardiol., July 1, 2001; 38(1): 11 - 18. [Abstract] [Full Text] [PDF]

				P. J. Hauptman, K. J. O'Connor, R. E. Wolf, and B. J. McNeil Angiography of potential cardiac donors J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1252 - 1258. [Abstract] [Full Text] [PDF]

				S. Dixit, M. Castle, R. P. Velu, L. Swisher, C. Hodge, and A. S. Jaffe Cardiac Involvement in Patients With Acute Neurologic Disease: Confirmation With Cardiac Troponin I Arch Intern Med, November 13, 2000; 160(20): 3153 - 3158. [Abstract] [Full Text] [PDF]

				N. Parekh, B. Venkatesh, D. Cross, A. Leditschke, J. Atherton, W. Miles, A. Winning, A. Clague, and C. Rickard Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1328 - 1335. [Abstract] [Full Text] [PDF]

				E Deibert, V Aiyagari, and M N Diringer Reversible left ventricular dysfunction associated with raised troponin I after subarachnoid haemorrhage does not preclude successful heart transplantation Heart, August 1, 2000; 84(2): 205 - 207. [Abstract] [Full Text] [PDF]

				S. Naredi, G. Lambert, E. Eden, S. Zall, M. Runnerstam, B. Rydenhag, and P. Friberg Increased Sympathetic Nervous Activity in Patients With Nontraumatic Subarachnoid Hemorrhage Stroke, April 1, 2000; 31(4): 901 - 906. [Abstract] [Full Text] [PDF]

				S. A. Mayer, J. Lin, S. Homma, R. A. Solomon, L. Lennihan, D. Sherman, M. E. Fink, A. Beckford, and L. M. Klebanoff Myocardial Injury and Left Ventricular Performance After Subarachnoid Hemorrhage Stroke, April 1, 1999; 30(4): 780 - 786. [Abstract] [Full Text] [PDF]

				M Morikawa, H Sato, H Sato, Y Koretsune, Y Ohnishi, T Kurotobi, T Kuzuya, and M Hori Sustained left ventricular diastolic dysfunction after exercise in patients with dilated cardiomyopathy Heart, September 1, 1998; 80(3): 263 - 269. [Abstract] [Full Text]

				P. J. Hauptman and K. J. O'Connor Procurement and Allocation of Solid Organs for Transplantation N. Engl. J. Med., February 6, 1997; 336(6): 422 - 431. [Full Text] [PDF]