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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
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
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
Internet cím:DOI
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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
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
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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