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Impact of transpulmonary thermodilution-based cardiac contractility and extravascular lung water measurements on clinical outcome of patients with Takotsubo cardiomyopathy after subarachnoid hemorrhage: a retrospective observational study.
MedLine Citation:
PMID:  25113260     Owner:  NLM     Status:  Publisher    
IntroductionTakotsubo cardiomyopathy (TCM) is a life-threatening systemic consequence early after subarachnoid hemorrhage (SAH), but precise hemodynamics and related outcome have not been studied. The purpose of this study was to investigate the TCM-induced cardiac function by transpulmonary thermodilution and its impact on clinical outcome of SAH.MethodsWe retrospectively analyzed 46 consecutive postoperative SAH patients who developed TCM. Patients were divided into two groups of echocardiographic left ventricular ejection fraction (LVEF)¿<¿40% (TCM with left ventricular (LV) dysfunction) and LVEF ¿40% (TCM without LV dysfunction). Cardiac function index (CFI) and extravascular lung water index (ELWI) were monitored by transpulmonary thermodilution, in parallel with serial measurements of echocardiographic parameters and blood biochemical markers.ResultsTranspulmonary thermodilution-derived cardiac function index (CFI) was significantly correlated with (LVEF) (r¿=¿0.82, P¿<¿0.0001). The CFI between day 0 to day 7 was significantly lower in patients with LV dysfunction (LVEF <40%) than in patients with LVEF ¿40% (P¿<¿0.05). CFI had a better ability than cardiac output to detect cardiac dysfunction (LVEF¿<¿40%) (area under the curve: 0.85¿±¿0.02; P¿<¿0.001). A CFI value of¿<¿4.2 min¿1 had a sensitivity of 82% and specificity of 84% for detecting LVEF <40%. The CFI¿<¿4.2 min¿1 was associated with delayed cerebral ischemia (DCI) (odds ratio (OR), 2.14; 95% confidence interval (CI), 1.33¿2.86; P¿=¿0.004) and poor 3-month functional outcome on modified Rankin Scale of 4¿6 (OR, 1.87; 95% CI, 1.06¿3.29; P¿=¿0.02). An extravascular lung water index (ELWI)¿>¿14 mL/kg after day 4 increased the risk of poor functional outcome at 3-month follow-up (OR, 2.10; 95% CI, 1.11¿3.97; P¿=¿0.04).ConclusionsProlonged cardiac dysfunction and pulmonary edema increased the risk of DCI and poor 3-month functional outcome in patients with SAH suffering from TCM. Serial measurements of CFI and ELWI by transpulmonary thermodilution may provide an easy bedside method of detecting early changes of the cardiopulmonary function in directing proper post-SAH treatment.
Tatsushi Mutoh; Ken Kazumata; Shunsuke Terasaka; Yasuyuki Taki; Akifumi Suzuki; Tatsuya Ishikawa
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-12
Journal Detail:
Title:  Critical care (London, England)     Volume:  18     ISSN:  1466-609X     ISO Abbreviation:  Crit Care     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-8-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9801902     Medline TA:  Crit Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  482     Citation Subset:  -    
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