Abstract 12857: Echocardiographic Patterns of Post-cardiac Arrest Myocardial Dysfunction

Abstract

Purpose: Post-cardiac arrest myocardial dysfunction can be developed after successful resuscitation from cardiac arrest. However, echocardiographic patterns of post-cardiac arrest myocardial dysfunction are not yet known. The purpose of this study was to investigate the manifestations of post-cardiac arrest myocardial dysfunction with serial echocardiography during post-cardiac arrest period. Materials and Methods: We enrolled non-traumatic out-of-hospital cardiac arrest patients older than 18 years old who were successfully resuscitated after CPR. The patients with myocardial infarction and pre-existing cardiac disease including heart failure or myocardial disease were excluded. Transthoracic echocardiography was performed within 24 hours, between 24 to 48 hours, after 48 hour since restoration of spontaneous circulation (ROSC) was achieved. Results: Out of 263 patients, 186 patients (122 males) were enrolled in the analysis. No left ventricular (LV) dysfunction was observed in 120 patients (64.5%). Abnormal LV dysfunction was observed in 66 patients (35.5%). Abnormal LV dysfunctions included global hypokinesis in 32 patients (17.2%), regional wall motion abnormalities (RWMA) in 25 patients (13.4%), and abnormalities like stress-induced cardiomyopathy in 9 patients (4.8%). There were no differences in etiology (p=0.275), duration of cardiac arrest (p=0.078), cumulative dose of epinephrine (p=0.336), and hospital mortality (p=0.140) according to the pattern of post-cardiac arrest myocardial dysfunction. In subgroup analysis of the patients with shockable rhythm, cumulative defibrillation energy (joules) was lower in patients without LV dysfunction (101±41) than in patients with RWMA (200±74) or global hypokinesis (408±131) (p=0.011). Cut-off value of 220 J had 21% of sensitivity and 91% of specificity for development of LV dysfunction (AUC=0.572). Conclusion: Post-cardiac arrest myocardial dysfunction occurs in one thirds of patients resuscitated from cardiac arrest. Echocardiographic patterns of post-cardiac arrest LV dysfunction include global hypokinesis, regional wall motion abnormalities, and abnormalities like stress-induced cardiomyopathy.