Neurogenic Stress Cardiomyopathy After Subarachnoid Hemorrhage: Who Is at Risk?

Introduction: Neurogenic Stress Cardiomyopathy is a rare complication of subarachnoid hemorrhage associated with increased morbidity and poor clinical outcomes. There is a scarcity of literature describing the incidence and risk factors associated with this complication. The aim of this study was to identify patients who are at risk of developing neurogenic stress cardiomyopathy in subarachnoid hemorrhage.

Methods: The 2016 to 2020 National Inpatient Sample (NIS) was used to identify adult inpatients with a primary diagnosis of non-traumatic subarachnoid hemorrhage. Univariate and multivariable analyses adjusting for patient demographics, comorbidity status, and hemorrhage etiology were used to characterize statistical associations with disease-related complications.

Results: A total of 149,465 patients were identified as having a subarachnoid hemorrhage from 2016 to 2020. Of these patients 2530 patients (1.69%) were found to have neurogenic stress cardiomyopathy. Neurogenic stress cardiomyopathy was associated with increased length of stay (20.30±0.37 vs.12.01±0.03, p< 0.001), increased total costs ($487,887.46±8392.56 vs. $266,701.75±804.36, p< 0.001), increased number of procedures (10.22±0.13 vs. 5.5±0.01, p< 0.001) and increased mortality (30.6% vs. 18.5%, p< 0.001). After controlling for confounding factors, independent risk factors for neurogenic stress cardiomyopathy in patients with subarachnoid hemorrhage included: subarachnoid hemorrhage from anterior communicating artery (Odds Ratio [OR]:1.92, 95% Confidence Interval [CI]:1.41-2.61, p< 0.001), subarachnoid hemorrhage from posterior communicating artery (OR:1.51, CI:1.11-2.07, p=0.01), subarachnoid hemorrhage from basilar artery (OR:2.52, CI:1.82-3.50, p< 0.001), subarachnoid hemorrhage from vertebral artery (OR:2.32, CI:1.55-3.47, p< 0.001), anemia (OR:1.36, CI:1.24-1.49, p< 0.001), coagulation deficiencies/disorders (OR:1.51, CI:1.32-1.76, p< 0.001), and cocaine and nicotine use (OR:1.23, CI:1.12-1.35, p< 0.001).

Conclusion : Neurogenic stress cardiomyopathy after subarachnoid hemorrhage is associated with increased mortality, length of stay, total cost, number of procedures in patients, and number of days to first procedure. Neurosurgeons should be aware of the comorbidities and factors associated with increased neurogenic stress cardiomyopathy after subarachnoid hemorrhage in order to improve patient outcomes.