What is the clinical evidence from this study?

Study design: Observational. Population: Adults aged 18-80 with aneurysmal subarachnoid hemorrhage (aSAH) treated at two academic tertiary-care institutions (n=311). Intervention: vasopressor use after aneurysm securement vs. no vasopressor use. Primary outcome: Development of Takotsubo cardiomyopathy (TCM) during hospital stay diagnosed by echocardiogram (OR 4.275, 95% CI 0.295–61.952, p=0.287).

What does this research mean for the field?

Vasopressor use is not predictive of Takotsubo cardiomyopathy development in aneurysmal subarachnoid hemorrhage patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study assesses the relationship between vasopressor use and takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage patients.

February 19, 2026Open Access

Pressor use and its impact on outcomes in aneurysmal subarachnoid hemorrhage patients with takotsubo cardiomyopathy: a quantitative analysis

Key Result

Vasopressor use was not predictive of Takotsubo cardiomyopathy development in aneurysmal subarachnoid hemorrhage patients on multivariate analysis (OR 4.275, 95% CI 0.295–61.952, p = 0.287).

Key Points

This study assesses the relationship between vasopressor use and takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage patients.
Multi-institutional chart review of adult aSAH patients from 2015 to 2021
TCM diagnosis served as the primary endpoint
Collected data on demographics, clinical presentation, and vasopressor usage
Analyzed outcomes related to TCM diagnosis and vasopressor use
4.2% of patients had a TCM diagnosis
Vasopressor use after aneurysm securement was associated with TCM diagnosis
On multivariate analysis, vasopressor use was not predictive of TCM
Higher incidence of adverse outcomes was noted in the TCM group compared to others

Study Design

Type

Observational (n=311)

Multicenter

Yes

Structured PICO

Does vasopressor use increase the risk of developing Takotsubo cardiomyopathy in patients with aneurysmal subarachnoid hemorrhage?

Population

311 adult patients (aged 18 to 80 years) with aneurysmal subarachnoid hemorrhage (aSAH) treated at two academic tertiary-care institutions from 2015 to 2021. Exclusions included pregnancy, non-aneurysmal or unknown etiology SAH, prior aSAH, pediatric patients, mycotic aneurysm, presentation greater than 48 hours after symptom onset, or care withdrawn prior to treatment.

Intervention

Vasopressor use (primarily norepinephrine, vasopressin, phenylephrine, dobutamine, or milrinone) for blood pressure augmentation, measured in average daily norepinephrine equivalents.

Comparator

No vasopressor use or lower doses of vasopressors.

Outcome

Development of Takotsubo cardiomyopathy (TCM) during the hospital stay, identified by echocardiographic diagnosis based on attending cardiologist interpretation.hard clinical

In patients with aneurysmal subarachnoid hemorrhage, vasopressor use for blood pressure augmentation was not an independent predictor of developing Takotsubo cardiomyopathy.

Main Result

Effect estimate: OR 4.275 (95% CI 0.295–61.952)

Absolute Event Rate: 4.2% vs 95.8%

p-value: p=0.287

Limitations

Retrospective design with possible incomplete datasets and lack of long-term outcome data.
Potential selection bias in echocardiogram ordering and institutional protocol differences.
Small number of TCM patients leading to low statistical power and wide confidence intervals.
Single region cohort largely Caucasian from the Midwest limiting generalizability.
TCM diagnosis based solely on echocardiogram without EKG criteria which may affect diagnosis accuracy.

Abstract

Abstract Purpose Takotsubo cardiomyopathy (TCM) is induced by catecholamine-induced cardiotoxicity. Though uncommon after aneurysmal subarachnoid hemorrhage (aSAH), TCM increases patient morbidity and mortality in an already-devastating disease process. The fear of worsening shock in TCM with blood pressure augmentation in patients with symptomatic vasospasm poses a dilemma for clinicians. This study aims to assess the relationship between vasopressor use after aSAH and TCM. Method A multi-institutional chart review evaluated aSAH adult patients treated from 2015 to 2021. TCM diagnosis was the primary endpoint upon which the group was stratified. Baseline demographics, clinical presentation, aneurysm characteristics, adverse events, short-term outcomes, treatment variables, and vasopressor usage in average daily norepinephrine equivalent were collected. Results 311 patients were included; 13 (4.2%) had a TCM diagnosis. Median TCM diagnosis day was post-bleed day 4 (IQR 2–5). High-grade rupture (Hunt Hess score ≥ 3) was associated with TCM ( p = 0.010). Vasopressor use after aneurysm securement was associated with TCM ( p < 0.001). Vasospasm requiring multiple endovascular treatments, myocardial infarction, prolonged intubation, and general poor outcomes were significantly more prevalent in the TCM group on univariate analysis. On multivariate analysis, vasopressor use was not significantly associated with TCM (OR 4.275, CI 0.295–61.952, p = 0.287). Conclusion In this sample of aSAH patients, a majority of TCM diagnoses were made within 5 days post-bleed. Most TCM patients were diagnosed prior to vasopressor initiation. Vasopressor use was not predictive of TCM in aSAH patients on multivariate analysis, suggesting its use is not a factor, though further study is needed.

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