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001-es BibID:BIBFORM102086
035-os BibID:(cikkazonosító)e0268525 (WOS)000835048800009 (Scopus)85130851932
Első szerző:Molnár Csilla (aneszteziológus)
Cím:Takotsubo cardiomyopathy in patients suffering from acute non-traumatic subarachnoid hemorrhage : A single center follow-up study / Molnár Csilla, Gál Judit, Szántó Dorottya, Fülöp László, Szegedi Andrea, Siró Péter, Nagy V. Endre, Lengyel Szabolcs, Kappelmayer János, Fülesdi Bela
Dátum:2022
ISSN:1932-6203
Megjegyzések:Background Takotsubo cardiomyopathy (TTC) is an important complication of subarachnoid hemorrhage (SAH), that may delay surgical or endovascular treatment and may influence patient outcome. This prospective follow-up study intended to collect data on the prevalence, severity, influencing factors and long-term outcome of TTC in patients suffering from non-traumatic SAH. Methods Consecutive patients admitted with the diagnosis of non-traumatic SAH were included. Intitial assessment consisted of cranial CT, Hunt-Hess, Fisher and WFNS scoring, 12-lead ECG, transthoracic echocardiography (TTE), transcranial duplex sonography and collecting laboratory parameters (CK, CK-MB, cardiac troponin T, NT-proBNP and urine metanephrine and normetanephrine). Diagnosis of TTC was based on modified Mayo criteria. TTC patients were dichotomized to mild and severe forms. Follow-up of TTE, Glasgow Outcome Scale assessment, Barthel's and Karnofsky scoring occurred on days 30 and 180. Results One hundred thirty six patients were included. The incidence of TTC in the entire cohort was 28.7%; of them, 20.6% and 8.1% were mild and severe, respectively. TTC was more frequent in females (30/39; 77%) than in males (9/39; 23%) and was more severe. The occurrence of TTC was related to mFisher scores and WFNS scores. Although the severity of TTC was related to mFisher score, Hunt-Hess score, WFNS score and GCS, multivariate analysis showed the strongest relationship with mFisher scores. Ejection fraction differences between groups were present on day 30, but disappeared by day 180, whereas wall motion score index was still higher in the severe TTC group at day 180. By the end of the follow-up period (180 days), 70 (74.5%) patients survived in the non-TTC, 22 (81.5%) in the mild TTC and 3 (27%) in the severe TTC group (n = 11) (p = 0.002). At day 180, GOS, Barthel, and Karnofsky outcome scores were higher in patients in the control (non-TTC) and the mild TTC groups than in the severe TTC group. Conclusions Takotsubo cardiomyopathy is a frequent finding in patients with SAH, and severe TTC may be present in 8% of SAH cases. The severity of TTC may be an independent predictor of mortality and outcome at 6 months after disease onset. Therefore, a regular follow-up of ECG and TTE abnormalities is warranted in patients with subrachnoid hemorrhage for early detection of TTC.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Plos One. - 17 : 5 (2022), p. 1-20. -
További szerzők:Gál Judit (1977-) (aneszteziológiai és ITO szakorvos) Szántó Dorottya (1991-) (aneszteziológus, intenzív terápiás szakorvos) Fülöp László (1976-) (kardiológus) Szegedi Andrea (kardiológus) Siró Péter (1973-) (neurológus, aneszteziológus, intenzív terápiás szakorvos) Nagy Endre V. (1957-) (belgyógyász, endokrinológus) Lengyel Szabolcs (1981-) (belgyógyász) Kappelmayer János (1960-) (laboratóriumi szakorvos) Fülesdi Béla (1961-) (aneszteziológus)
Pályázati támogatás:Nemzeti Agykutatási Projekt
Egyéb
Internet cím:DOI
Intézményi repozitóriumban (DEA) tárolt változat
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001-es BibID:BIBFORM112757
035-os BibID:(cikkazonosító)177 (WoS)001025509200004 (Scopus)85164007315
Első szerző:Szántó Dorottya (aneszteziológus, intenzív terápiás szakorvos)
Cím:Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage : a Comprehensive Review / Dorottya Szántó, Péter Luterán, Judit Gál, Endre V. Nagy, Béla Fülesdi, Csilla Molnár
Dátum:2023
ISSN:1530-6550 2153-8174
Megjegyzések:Takotsubo syndrome (TS) is a frequent complication of subarachnoid hemorrhage (SAH), especially in massive SAH with severe neurological damage. The initial presentation of TS is similar to acute coronary syndrome, causing differential diagnostic issues. Unnecessary diagnostic steps and uncertainty in therapy may delay the definitive treatment of the aneurysm, therefore increasing the risk of rebleeding. The purpose of this review is to summarize the latest knowledge on the diagnosis and therapy of TS in SAH and to provide a diagnostic and therapeutic algorithm for the acute phase, promoting the early definitive treatment of the aneurysm. Rapid hemodynamic stabilization and early aneurysm securing are key points in reducing the risk of delayed cerebral ischemia and improving outcomes. In acute SAH noninvasive bedside diagnostic methods are preferred and securing the aneurysm is the priority. The combination of electrocardiography, cardiac biomarkers, and echocardiography is of great importance in differentiating TS from acute myocardial infarction. The risk-benefit ratio of coronary angiography should be carefully and individually considered and its use should be limited to patients with strong evidence of myocardial ischemia, after the successful endovascular treatment of the aneurysm. Invasive hemodynamic monitoring may be beneficial in cases of cardiogenic shock or pulmonary edema. In patients with hemodynamical instability secondary to TS, the use of non-catecholamine inotropes, especially levosimendan is recommended. In refractory hypotension, mechanical support should be considered. The left ventricular function improves within days to months after the acute event, low initial ejection fraction may predispose to delayed recovery.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Takotsubo syndrome
subarachnoid hemorrhage
neurogenic stunned myocardium
delayed cerebral ischemia
intracranial aneurysm treatment
Megjelenés:Reviews in Cardiovascular Medicine. - 24 : 6 (2023), p. 177-189. -
További szerzők:Luterán Péter (1991-) (aneszteziológus) Gál Judit (1977-) (aneszteziológiai és ITO szakorvos) Nagy Endre V. (1957-) (belgyógyász, endokrinológus) Fülesdi Béla (1961-) (aneszteziológus) Molnár Csilla (1962-) (aneszteziológus)
Pályázati támogatás:ELKH-DE Cerebrovascular Research Grop
MTA
TKCS-2021/60).
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Internet cím:Szerző által megadott URL
DOI
Intézményi repozitóriumban (DEA) tárolt változat
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