Myocardial dysfunction assessed by Speckle-Tracking in good-grade subarachnoid hemorrhage patients (WFNS 1-2) A prospective observational study

Background: Cardiac complications due to non-traumatic subarachnoid hemorrhage (SAH) are usually described using classical echocardiographic evaluation. Strain imaging appears to have better sensitivity than standard echocardiographic markers for the diagnosis of left ventricular dysfunction. The aim of this study was to determine the prevalence of cardiac dysfunction defined as a Global Longitudinal Strain (GLS) ≥-20% in patients with good-grade SAH (WFNS 1 or 2). Methods: Seventy-six patients with good-grade SAH were prospectively enrolled and analyzed at admission for neurocritical care. Transthoracic echocardiography was performed on days 1, 3, and 7 after hemorrhage. Routine measurements, including left ventricular ejection fraction (LVEF), were performed. Off-line analysis was performed by a blinded examiner, to determine 2-, 3-, and 4-cavity longitudinal strain and left ventricular GLS. GLS was considered altered if it was ≥ -20%. LVEF was considered altered if it was < 50%. Results: 60.6% of patients had GLS ≥ -20% on day 1, followed by 55.3% and 56.4% on days 3 and 7, respectively. In comparison, alteration of LVEF was present in only 1.7% of patients on day 1, 1.4% on day 3, and 5.9% on day 7. The concordance rate between LVEF < 50% and GLS ≥ -20% and LVEF ≥ 50% and GLS < -20% was 46%. Troponin elevations and ECG abnormalities on day 1 were present in 50% and 52% of patients, respectively. Conclusion: Strain imaging showed a higher prevalence (60.6%) of left ventricular dysfunction during the acute phase of good-grade SAH (WFNS 1 or 2) than previously described.