{
  "abstract": "Background Cardiac complications are well established in subarachnoid haemorrhage (SAH) and are associated with increased morbidity and mortality, despite often being reversible. 1 Management of cardiomyopathy following SAH, including Takotsubo syndrome, remains largely conservative and focuses on supportive care and monitoring with electrocardiography (ECG), transthoracic echocardiography (TTE), and cardiac biomarkers such as troponin and NT-proBNP.2 3 To date, formal guidelines in the context of SAH for the optimal diagnosis and management of cardiomyopathy, including Takotsubo, have not been established.Methods A cohort of 264 patients with acute spontaneous SAH admitted to critical care at the National Hospital for Neurology and Neurosurgery (NHNN) between 2019 and 2023 was retrospectively analysed. Presentation severity was assessed using the World Federation of Neurosurgical Societies (WFNS) SAH grading system and cardiac involvement determined by the presence of abnormal troponin T, NT-proBNP, and ECG and echocardiographic abnormalities. Electronic patient records provided all the metrics measured.Results and Discussion Of the 264 patients with SAH, evidence of cardiac involvement was identified in 74 patients (28%). Admission troponin T was available in 206 patients, of whom 46 (22%) had levels >10× the upper reference limit (URL; >140 ng/L) and 9 (4%) had levels 5-10× URL (71-140 ng/L). NT-proBNP was measured in 109 patients: 40 (37%) had peak levels >900 pg/mL, 28 (26%) had levels between 300-900 pg/mL, and 41 (38%) had levels <300 pg/mL. Transthoracic echocardiography was performed in 218 patients, with abnormal findings identified in 33 patients (13% of entire cohort), including left ventricular systolic dysfunction and regional wall motion abnormalities. Ischaemic ECG changes (TWI/ST elevation) were seen in 38 patients (14%).Subarachnoid haemorrhage severity (WFNS) was significantly higher in patients with cardiac complications (mean 3.4, n=74) than those without (mean 2.2, n=190), a mean difference of +1.2 grades (95% CI 0.74-1.60; Mann-Whitney p < 0.01).All-cause mortality was higher in patients with cardiac involvement at 30 days (26% vs 7%), 6 months (30% vs 10%), and 1 year (36% vs 11%). In WFNS-adjusted Cox models. Cardiac involvement overall, was associated with higher mortality, with an adjusted hazard ratio (aHR) of 1.73 (95% CI: 0.73–4.09, p = 0.21), with higher mortality at 30 days (aHR: 2.74, 95% CI: 0.83–9.05, p = 0.10), 6 months (aHR: 2.86, 95% CI: 0.96–8.50, p = 0.06), and 1 year (aHR: 2.21, 95% CI: 0.84–5.82, p = 0.11).Conclusion In this single-centre critical care cohort, cardiac involvement occurred in 28% of patients with subarachnoid haemorrhage and was associated with higher subarachnoid grade, and increased early and long-term mortality. Limited use of coronary assessment restricted differentiation between stress-induced cardiomyopathy and myocardial infarction. These findings highlight the prognostic importance of cardiac complications in SAH and the need for more consistent diagnostic pathways and standardised management strategies.References Ahmadian A, et al. Cardiac manifestations of subarachnoid hemorrhage. Heart Lung Vessel. 2013;5(3):168–78. PMID: 24364008; PMCID: PMC3848675.Arbelo E, et al. 2023 ESC guidelines for the management of cardiomyopathies: developed by the task force on the management of cardiomyopathies of the European society of cardiology (ESC). European Heart Journal 1 October 2023;44(37):3503–3626. doi.org/10.1093/eurheartj/ehad194Szántó D, et al. Diagnosis and management of takotsubo syndrome in acute aneurysmal subarachnoid hemorrhage: a comprehensive review. Rev Cardiovasc Med. 2023 Jun 19;24(6):177. doi: 10.31083/j.rcm2406177. PMID: 39077518",
  "authors": [
    {
      "affiliations": [
        "University College London Medical School, Huntley Street, London, United Kingdom"
      ],
      "name": "Trisha Saha"
    },
    {
      "affiliations": [
        "National Hospital for Neurology and Neurosurgery, Queens Square, London, United Kingdom"
      ],
      "name": "Joshua Fletcher"
    },
    {
      "affiliations": [
        "National Hospital for Neurology and Neurosurgery, Queens Square, London, United Kingdom"
      ],
      "name": "Ugan Reddy"
    },
    {
      "affiliations": [
        "National Hospital for Neurology and Neurosurgery, Queens Square, London, United Kingdom",
        "Department of Cardiology, Medical Specialties, University College London Hospitals NHS Trust, London, United Kingdom"
      ],
      "name": "Robert Bell"
    }
  ],
  "title": "107 Cardiac complications and stress following subarachnoid haemorrhage: exploring therapeutic approaches and evidence gaps",
  "uid": "c78b79f4-ddd8-575f-825e-2c8bddc5591d"
}