Neurocardiac injury detected by strain imaging appears to be a marker for the extent of neurological insult, and is a new prognostic marker in patients with subarachnoid hemorrhage (SAH), according to a prospective longitudinal observational study published in the Journal of the American College of Cardiology: Cardiovascular Imaging.1

Aneurysmal SAH is a life-threatening disease associated with variable degrees of neurocardiac injury.2 Strain imaging by speckle tracking echocardiography may quantify left ventricular (LV) function and has the potential to detect subtle myocardial dysfunction, which is additive to conventional measurements.1 Thus, researchers tested whether speckle tracking strain echocardiography can quantify neurocardiac injury in 255 patients with aneurysmal SAH who were admitted to the intensive care unit with echocardiography within 72 hours.

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Investigators report that an abnormal LV global longitudinal strain was observed in 53 patients (24%), and was associated with worse clinical severity. LV global longitudinal strain was more significantly associated with in-hospital mortality compared with LV ejection fraction, even after adjusting for clinical severity. Right ventricular strain, when available, had additive prognostic value to LV global longitudinal strain. The investigators proposed abnormal myocardial strain as a marker for an increased risk for in-hospital mortality in SAH and suggested its utility as a clinical prognostic tool.

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The researchers concluded that their study “demonstrates that cardiac strain imaging is an effective means to quantify neuro-cardiac injury associated with clinical outcomes in a large prospective series of patients with aneurysmal SAH.”1 In addition, “The study results suggested that subtle myocardial dysfunction can be appreciated by strain echocardiography and is associated with poor clinical outcome.”


1. Kagiyama N, Sugahara M, Crago EA, et al. Neurocardiac injury by strain imaging is associated with in-hospital mortality in patients with subarachnoid hemorrhage [published online May 9, 2019]. JACC Cardiovasc Imaging. doi:10.1016/j.jcmg.2019.02.023

2. Lawton MT, Vates GE. Subarachnoid hemorrhage. N Engl J Med. 2017;377:257-266.