Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy

Joji Inamasu, Tsukasa Ganaha, Shunsuke Nakae, Tatsuo Ohmi, Akira Wakako, Riki Tanaka, Kiyonori Kuwahara, Hirotaka Kogame, Yushi Kawazoe, Tadashi Kumai, Motoharu Hayakawa, Yuichi Hirose

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Background: There are no guidelines regarding the optimal treatment of subarachnoid hemorrhage (SAH) patients complicated by Takotsubo cardiomyopathy (TCM). Although coiling has been favored as the first-line treatment, clipping may also be indicated in patients with ruptured middle cerebral artery aneurysms or in those with massive intracerebral hemorrhage. The study objective is (1) to report the feasibility/safety of clipping/coiling and (2) to identify possible prognosticators in that population. Methods: Between January 2008 and December 2014, 371 consecutive patients with aneurysmal SAH underwent transthoracic echocardiography after admission, and 30 with TCM (7.7 %) were identified. We reviewed the incidence and type of perioperative complications among clipped (n = 11) and coiled (n = 19) patients. The 30 patients were dichotomized based on their 90-day modified Rankin scale (mRS) scores into favorable (mRS: 0–2) and unfavorable (mRS: 3–6) groups, and their demographic, laboratory and echocardiographic variables were compared. Results: Neither clipped nor coiled patients developed serious perioperative cardiopulmonary complications, but coiled patients had a higher incidence of fatal procedure-related complications. Among the 30 patients, 13 (43 %) had favorable 90-day outcomes, and the favorable group was significantly younger. Age, but not the degree of cardiac dysfunction, correlated with outcomes by multivariate regression analysis. Conclusions: Clipping was shown to be a safe treatment modality in our cohort, and treatment selection may better be made on a case-by-case basis in most patients with SAH-induced TCM. The lack of correlation between the degree of cardiac dysfunction and outcomes indicates that aggressive intervention is justified in patients with severely impaired cardiac function.

Original languageEnglish
Pages (from-to)885-893
Number of pages9
JournalActa Neurochirurgica
Volume158
Issue number5
DOIs
Publication statusPublished - 01-05-2016

Fingerprint

Takotsubo Cardiomyopathy
Subarachnoid Hemorrhage
Therapeutics
Incidence
Cerebral Hemorrhage
Intracranial Aneurysm
Echocardiography
Multivariate Analysis
Regression Analysis
Demography
Guidelines

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Inamasu, Joji ; Ganaha, Tsukasa ; Nakae, Shunsuke ; Ohmi, Tatsuo ; Wakako, Akira ; Tanaka, Riki ; Kuwahara, Kiyonori ; Kogame, Hirotaka ; Kawazoe, Yushi ; Kumai, Tadashi ; Hayakawa, Motoharu ; Hirose, Yuichi. / Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy. In: Acta Neurochirurgica. 2016 ; Vol. 158, No. 5. pp. 885-893.
@article{51b46187a15544fe934edba20a616ac4,
title = "Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy",
abstract = "Background: There are no guidelines regarding the optimal treatment of subarachnoid hemorrhage (SAH) patients complicated by Takotsubo cardiomyopathy (TCM). Although coiling has been favored as the first-line treatment, clipping may also be indicated in patients with ruptured middle cerebral artery aneurysms or in those with massive intracerebral hemorrhage. The study objective is (1) to report the feasibility/safety of clipping/coiling and (2) to identify possible prognosticators in that population. Methods: Between January 2008 and December 2014, 371 consecutive patients with aneurysmal SAH underwent transthoracic echocardiography after admission, and 30 with TCM (7.7 {\%}) were identified. We reviewed the incidence and type of perioperative complications among clipped (n = 11) and coiled (n = 19) patients. The 30 patients were dichotomized based on their 90-day modified Rankin scale (mRS) scores into favorable (mRS: 0–2) and unfavorable (mRS: 3–6) groups, and their demographic, laboratory and echocardiographic variables were compared. Results: Neither clipped nor coiled patients developed serious perioperative cardiopulmonary complications, but coiled patients had a higher incidence of fatal procedure-related complications. Among the 30 patients, 13 (43 {\%}) had favorable 90-day outcomes, and the favorable group was significantly younger. Age, but not the degree of cardiac dysfunction, correlated with outcomes by multivariate regression analysis. Conclusions: Clipping was shown to be a safe treatment modality in our cohort, and treatment selection may better be made on a case-by-case basis in most patients with SAH-induced TCM. The lack of correlation between the degree of cardiac dysfunction and outcomes indicates that aggressive intervention is justified in patients with severely impaired cardiac function.",
author = "Joji Inamasu and Tsukasa Ganaha and Shunsuke Nakae and Tatsuo Ohmi and Akira Wakako and Riki Tanaka and Kiyonori Kuwahara and Hirotaka Kogame and Yushi Kawazoe and Tadashi Kumai and Motoharu Hayakawa and Yuichi Hirose",
year = "2016",
month = "5",
day = "1",
doi = "10.1007/s00701-016-2768-6",
language = "English",
volume = "158",
pages = "885--893",
journal = "Acta Neurochirurgica",
issn = "0001-6268",
publisher = "Springer Wien",
number = "5",

}

Inamasu, J, Ganaha, T, Nakae, S, Ohmi, T, Wakako, A, Tanaka, R, Kuwahara, K, Kogame, H, Kawazoe, Y, Kumai, T, Hayakawa, M & Hirose, Y 2016, 'Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy', Acta Neurochirurgica, vol. 158, no. 5, pp. 885-893. https://doi.org/10.1007/s00701-016-2768-6

Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy. / Inamasu, Joji; Ganaha, Tsukasa; Nakae, Shunsuke; Ohmi, Tatsuo; Wakako, Akira; Tanaka, Riki; Kuwahara, Kiyonori; Kogame, Hirotaka; Kawazoe, Yushi; Kumai, Tadashi; Hayakawa, Motoharu; Hirose, Yuichi.

In: Acta Neurochirurgica, Vol. 158, No. 5, 01.05.2016, p. 885-893.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy

AU - Inamasu, Joji

AU - Ganaha, Tsukasa

AU - Nakae, Shunsuke

AU - Ohmi, Tatsuo

AU - Wakako, Akira

AU - Tanaka, Riki

AU - Kuwahara, Kiyonori

AU - Kogame, Hirotaka

AU - Kawazoe, Yushi

AU - Kumai, Tadashi

AU - Hayakawa, Motoharu

AU - Hirose, Yuichi

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background: There are no guidelines regarding the optimal treatment of subarachnoid hemorrhage (SAH) patients complicated by Takotsubo cardiomyopathy (TCM). Although coiling has been favored as the first-line treatment, clipping may also be indicated in patients with ruptured middle cerebral artery aneurysms or in those with massive intracerebral hemorrhage. The study objective is (1) to report the feasibility/safety of clipping/coiling and (2) to identify possible prognosticators in that population. Methods: Between January 2008 and December 2014, 371 consecutive patients with aneurysmal SAH underwent transthoracic echocardiography after admission, and 30 with TCM (7.7 %) were identified. We reviewed the incidence and type of perioperative complications among clipped (n = 11) and coiled (n = 19) patients. The 30 patients were dichotomized based on their 90-day modified Rankin scale (mRS) scores into favorable (mRS: 0–2) and unfavorable (mRS: 3–6) groups, and their demographic, laboratory and echocardiographic variables were compared. Results: Neither clipped nor coiled patients developed serious perioperative cardiopulmonary complications, but coiled patients had a higher incidence of fatal procedure-related complications. Among the 30 patients, 13 (43 %) had favorable 90-day outcomes, and the favorable group was significantly younger. Age, but not the degree of cardiac dysfunction, correlated with outcomes by multivariate regression analysis. Conclusions: Clipping was shown to be a safe treatment modality in our cohort, and treatment selection may better be made on a case-by-case basis in most patients with SAH-induced TCM. The lack of correlation between the degree of cardiac dysfunction and outcomes indicates that aggressive intervention is justified in patients with severely impaired cardiac function.

AB - Background: There are no guidelines regarding the optimal treatment of subarachnoid hemorrhage (SAH) patients complicated by Takotsubo cardiomyopathy (TCM). Although coiling has been favored as the first-line treatment, clipping may also be indicated in patients with ruptured middle cerebral artery aneurysms or in those with massive intracerebral hemorrhage. The study objective is (1) to report the feasibility/safety of clipping/coiling and (2) to identify possible prognosticators in that population. Methods: Between January 2008 and December 2014, 371 consecutive patients with aneurysmal SAH underwent transthoracic echocardiography after admission, and 30 with TCM (7.7 %) were identified. We reviewed the incidence and type of perioperative complications among clipped (n = 11) and coiled (n = 19) patients. The 30 patients were dichotomized based on their 90-day modified Rankin scale (mRS) scores into favorable (mRS: 0–2) and unfavorable (mRS: 3–6) groups, and their demographic, laboratory and echocardiographic variables were compared. Results: Neither clipped nor coiled patients developed serious perioperative cardiopulmonary complications, but coiled patients had a higher incidence of fatal procedure-related complications. Among the 30 patients, 13 (43 %) had favorable 90-day outcomes, and the favorable group was significantly younger. Age, but not the degree of cardiac dysfunction, correlated with outcomes by multivariate regression analysis. Conclusions: Clipping was shown to be a safe treatment modality in our cohort, and treatment selection may better be made on a case-by-case basis in most patients with SAH-induced TCM. The lack of correlation between the degree of cardiac dysfunction and outcomes indicates that aggressive intervention is justified in patients with severely impaired cardiac function.

UR - http://www.scopus.com/inward/record.url?scp=84960343602&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960343602&partnerID=8YFLogxK

U2 - 10.1007/s00701-016-2768-6

DO - 10.1007/s00701-016-2768-6

M3 - Review article

C2 - 26960685

AN - SCOPUS:84960343602

VL - 158

SP - 885

EP - 893

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

SN - 0001-6268

IS - 5

ER -