Pressor use and its impact on outcomes in aneurysmal subarachnoid hemorrhage patients with takotsubo cardiomyopathy: a quantitative analysis.

PURPOSE: Takotsubo cardiomyopathy (TCM) is induced by catecholamine-induced cardiotoxicity. Though uncommon after aneurysmal subarachnoid hemorrhage (aSAH), TCM increases patient morbidity and mortality in an already-devastating disease process. The fear of worsening shock in TCM with blood pressure augmentation in patients with symptomatic vasospasm poses a dilemma for clinicians. This study aims to assess the relationship between vasopressor use after aSAH and TCM.

METHOD: A multi-institutional chart review evaluated aSAH adult patients treated from 2015 to 2021. TCM diagnosis was the primary endpoint upon which the group was stratified. Baseline demographics, clinical presentation, aneurysm characteristics, adverse events, short-term outcomes, treatment variables, and vasopressor usage in average daily norepinephrine equivalent were collected.

RESULTS

311 patients were included; 13 (4.2%) had a TCM diagnosis. Median TCM diagnosis day was post-bleed day 4 (IQR 2-5). High-grade rupture (Hunt Hess score ≥ 3) was associated with TCM (p = 0.010). Vasopressor use after aneurysm securement was associated with TCM (p < 0.001). Vasospasm requiring multiple endovascular treatments, myocardial infarction, prolonged intubation, and general poor outcomes were significantly more prevalent in the TCM group on univariate analysis. On multivariate analysis, vasopressor use was not significantly associated with TCM (OR 4.275, CI 0.295-61.952, p = 0.287).

CONCLUSION

In this sample of aSAH patients, a majority of TCM diagnoses were made within 5 days post-bleed. Most TCM patients were diagnosed prior to vasopressor initiation. Vasopressor use was not predictive of TCM in aSAH patients on multivariate analysis, suggesting its use is not a factor, though further study is needed.