Introduction: Aneurysmal subarachnoid hemorrhage (SAH) is associated with variable degrees of neuro-cardiac injury. Strain imaging is a sensitive means to quantify both left (LV) and right ventricular (RV) function. Effects of neuro-cardiac on biventricular function in SAH and their prognostic value are unknown.
Hypothesis: We hypothesized that in SAH, LV and RV dysfunction can be detected by LV and RV speckle tracking echocardiography (STE) and are associated with prognosis.
Methods: We studied 255 patients with acute SAH in the SAHMII study (R01NR04221). Using strain imaging obtained acutely (mean 2.3 days from bleed), LV global longitudinal strain (GLS) from 3 apical views and RV free wall strain from apical 4-chamber view were assessed. Strain values were presented in absolute values and LV strain < 17% and RV strain < 20% were defined as abnormal. In-hospital mortality was the outcome variable.
Results: LV and RV strain were feasible in 221 (89%) and 159 (64%) patients (7 were excluded with previous cardiac disease). There were 53 (23.9%) and 27 (17.0%) patients with abnormal LV and RV strain, respectively. In 15 (9.4%) patients, both LV and RV strain were abnormal (biventricular dysfunction). The patients with biventricular dysfunction had more severe neurological findings (Hunt-Hess grade 5: 13.3% vs. 6.7% vs. 1.8%, P=0.04) compared with the patients with single ventricular dysfunction and the patients with normal strain, respectively. Importantly, in patients with preserved LV ejection fraction (> 50%), those with abnormal biventricular strain values had significantly higher mortality than the patients with normal LV and RV strain (28.6% vs. 23.1% vs. 8.3% vs. 4.4%, P=0.015: Figure).
Conclusions: In SAH, LV and RV strain could detect biventricular neuro-cardiac injury, even in those patients with preserved LV ejection fraction. Evidence of biventricular neuro-cardiac injury was associated with in-hospital mortality and has prognostic utility.