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001-es BibID:	BIBFORM115389
035-os BibID:	(cikkazonosító)000240
Első szerző:	Szántó Dorottya (aneszteziológus, intenzív terápiás szakorvos)
Cím:	Incidence and characteristics of Takotsubo cardiomyopathy in subarachnoid haemorrhage: a prospective study / Szántó Dorottya, Gál Judit, Fülöp László, Szegedi Andrea, Fülesdi Béla, Molnár Csilla
Dátum:	2019
ISSN:	2197-425X
Megjegyzések:	INTRODUCTION. Takotsubo cardiomyopathy (TTC) is an acute, usually reversible heart failure syndrome, precipitated by emotional or physical stressors. The initial presentation of TTC has similar features to acute coronary syndrome, however, coronary angiography usually shows an absence of significant coronary artery disease. TTC has been previously described as a notable complication of SAH because of its impact on cerebral blood flow. OBJECTIVES. The aim of our prospective observational study was to investigate the incidence, predisposing factors and cardiac biomarkers of TTC associated with SAH. Our secondary goal was to evaluate its effect on outcome. METHODS. This study was conducted in our neurosugical intensive care unit between March 2015 and June 2018 (Clinical trials reg. Nr: NCT02659878). We enrolled non-traumatic SAH patients without a history of cardiac disease, who were admitted within 48 hours from symptom onset. On admission we noted the severity of the haemorrhage (modified Fisher score) and neurological state (Hunt-Hess and WFNS scores) and transthoracic echocardiogram was performed. Patients with wall motion abnormality (WMA) were diagnosed as TTC, TTC patients with ejection fraction lower than 40% were classified as severe TTC (sTTC), patients without WMA served as control group (CG). Cardiac necroenzyme detection and transcranial colour duplex was performed on a daily basis. Each patient went through follow-up echocardiograms. We evaluated Glasgow Outcome Scale (GOS) and Barthel Scale (BS) 30 days and 6 months after the onset of SAH. RESULTS. During the study period 136 patients fulfilled inclusion criteria. Incidence of TTC was 28,7% (n=39), sTTC was found in 8,1% (n=11) of the cases. TTC was more common among females than males (female/male: CG 50/47 vs. TTC 30/9, p=0,007). Higher modified Fisher score was more frequent in the TTC group (modified Fisher>2: TTC 32/39 vs. CG 54/97; p=0,004). Higher Hunt-Hess (HH> 3: sTTC 8/11 vs. CG 29/97; p=0,012) and WFNS-score (WFNS>3: sTTC 9/11 vs. CG 29/97; p=0,002) was characteristic for sTTC. Serious vasospasm had higher incidence in the sTTC group (sTTC 3/11 vs. CG 5/97; p=0,04). We found significantly elevated cTnT and NT-proBNP levels in TTC patients. On 1 and 6 month follow-up sTTC was related to increased mortality (sTTC vs. CG: 7/11 vs. 15/95, p<0,001; 8/11 vs. 24/93, p=0,004) and lower GOS score (GOS<4: sTTC vs. CG 11/11 vs 44/95, p=0,002; 9/11 vs. 32/93, p=0,007). At 30th day lower quality of life was observed in the sTTC group (BS<50: sTTC 4/4 vs. CG 23/79, p=0,016). CONCLUSION. TTC is a common cardiac complication of SAH, especially in serious SAH with severe neurological symptoms. cTnT and NT-proBNP properly signs the presence of TTC. The harmful effect of TTC on cerebral circulation may contribute to increased mortality and disability.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok konferenciacikk folyóiratcikk
Megjelenés:	Intensive Care Medicine Experimental. - 7 : Suppl. 3 (2019), p. 263. -
További szerzők:	Gál Judit (1977-) (aneszteziológiai és ITO szakorvos) Fülöp László (1976-) (kardiológus) Szegedi Andrea (kardiológus) Fülesdi Béla (1961-) (aneszteziológus) Molnár Csilla (1962-) (aneszteziológus)
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