Author + information
- Received November 13, 2018
- Revision received January 29, 2019
- Accepted February 6, 2019
- Published online May 15, 2019.
- Nobuyuki Kagiyama, MD, PhDa,
- Masataka Sugahara, MDb,
- Elizabeth A. Crago, RN, PhDc,
- Zhi Qi, MDb,
- Theodore F. Lagattuta, RNc,
- Khalil M. Yousef, RN, PhDc,d,
- Robert M. Friedlander, MDe,
- Marilyn T. Hravnak, RN, PhDc and
- John Gorcsan III, MDa,∗ ()
- aDivision of Cardiology, Washington University in St. Louis, St. Louis, Missouri
- bHeart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- cSchool of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
- dSchool of Nursing, University of Jordan, Jordan
- eDepartment of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- ↵∗Address for correspondence:
Dr. John Gorcsan III, Division of Cardiology, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8086, St. Louis, Missouri 63110.
Objectives This study sought to test the hypothesis that speckle tracking strain echocardiography can quantify neurocardiac injuries in patients with aneurysmal subarachnoid hemorrhage (SAH), which is associated with worse clinical outcome.
Background SAH may be a life-threatening disease associated with variable degrees of neurocardiac injury. Strain imaging has the potential to detect subtle myocardial dysfunction which is additive to conventional measurements.
Methods A total of 255 consecutive patients were prospectively enrolled with acute SAH, who were admitted to the intensive care unit with echocardiography studies within 72 h. Left ventricular (LV) and right ventricular (RV) strains were acquired from standard apical views. Abnormal LV global longitudinal strain (GLS) and RV free-wall strain were pre-defined as <17% and <23% (absolute values), respectively.
Results Performing LV GLS was feasible in 221 patients (89%) 53 ± 10 years of age, 71% female, after excluding those with previous cardiac disease. Abnormal LV GLS findings were observed in 53 patients (24%) and were associated with worse clinical severity, including a Hunt-Hess grade >3 (34% vs. 15%; p = 0.005) and biomarker evidence of neurocardiac injury and higher troponin values (1.50 [interquartile range (IQR): 0.01 to 3.87] vs. 0.01 [IQR: 0.01 to 0.22] ng/ml; p < 0.001). A reverse Takotsubo pattern of segmental strain was observed in 49% of patients (apical sparing and reduced basal strain). Importantly, LV GLS was more strongly associated with in-hospital mortality than left ventricular ejection fraction (LVEF), even after adjusting for clinical severity (odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.12 to 8.63; p = 0.029). RV strain was measured in 159 subjects (72%); abnormal RV strain was added to LV GLS for predicting in-hospital mortality (p = 0.007).
Conclusions Neurocardiac injury can be detected by LV GLS and RV strain in patients with acute SAH. LV GLS was significantly associated with in-hospital mortality. RV strain, when available, added prognostic value to LV GLS. Abnormal myocardial strain is a marker for increased risk of in-hospital mortality in SAH and has clinical prognostic utility.
- global longitudinal strain
- right ventricle
- speckle tracking echocardiography
- subarachnoid hemorrhage
Supported by U.S. National Institutes of Health grant R01NR04221. Dr. Friedlander is the Chief Medical Officer and a stockholder of Neubase Therapeutics; and is on the Scientific Advisory Board and a stockholder of Diffusion, Inc. Dr. Gorcsan has received research grants from Medtronic, GE Healthcare, Biotronik, Hitachi, and EBR Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 13, 2018.
- Revision received January 29, 2019.
- Accepted February 6, 2019.
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