Abstract 38: Intensive Monitoring of Cardiac Function and Extravascular Lung Water Predicts Outcome of Tako-tsubo Cardiomyopathy after Subarachnoid Hemorrhage

Abstract

Takotsubo cardiomyopathy (TCM) is a life-threatening systemic consequence early after subarachnoid hemorrhage (SAH), but precise hemodynamics and related outcome are not well-understood. We aimed to investigate the TCM-induced cardiac function by transpulmonary thermodilution and its impact on clinical outcome of SAH. Forty-six consecutive SAH patients who developed TCM and treated surgically or endovascularly were analyzed retrospectively. Patients were divided into two groups of LVEF <40% (TCM with LV dysfunction) and LVEF ≥40% (TCM without LV dysfunction). Cardiac function index (CFI) and extravascular lung water index (ELWI) were monitored by transpulmonary thermodilution. Transpulmonary thermodilution-derived CFI was correlated significantly with echocardiographic left ventricular ejection fraction (LVEF) ( r = 0.82, P <0.0001). The CFI between day 0 to day 7 was significantly lower in patients with LV dysfunction (LVEF <40%) than in patients with LVEF ≥40% ( P <0.05). CFI had a better ability than cardiac output to detect cardiac dysfunction (LVEF <40%) (Area under the curve: 0.85 ± 0.02; P <0.001). A CFI value of <4.2 min -1 had a sensitivity of 82% and specificity of 84% for detecting LVEF <40%. The CFI <4.2 min -1 was associated with delayed cerebral ischemia (DCI) (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.33-2.86; P = 0.004) and poor 3-month functional outcome on modified Rankin Scale of 4-6 (OR, 1.87; 95% CI, 1.06-3.29; P = 0.02). An ELWI >14 mL/kg after day 4 increased the risk of poor functional outcome at 3-month follow-up (OR, 2.10; 95% CI, 1.11-3.97; P = 0.04). In conclusion, prolonged cardiac dysfunction and pulmonary edema increased the risk of DCI and poor 3-month functional outcome in patients with SAH suffering from TCM. Serial measurements of CFI and ELWI by transpulmonary thermodilution may provide an easy bedside method of detecting early changes of the cardiopulmonary function in directing proper post-SAH treatment.