Evaluation of Neurogenic Myocardial Stunning by Two Dimensional Speckle Tracking Echocardiography

a defini- tion of reversible myocardial dysfunction resulting from dysregulation of the autonomic nervous system after an acute neurologic event. [1]NSM incidence varies between 20%-40%, depending on the neurological disease. [2]Although it has been reported mostly in subarachnoid hemorrhage (20-30% of cases); it can be seen after vari-ous neurological events such as cerebral trauma, ischemic stroke, seizure, encephalitis, and epilepsy. [3,4]NSM is characterized by increased troponin levels, new electrocardiographic (ECG) changes, and wall motion abnormalities with decreased left ventricular ejection fraction (LVEF). [5]Studies on NSM have shown a remarkable involvement of the insular cortex, which plays a role in the regulation of both car-Objectives: Neurogenic stunned myocardium (NSM) is a cardiac condition resulting from acute neurological events that can lead to a reduction in myocardial strain, an important parameter used to assess cardiac function.The aim of our study was to investigate the NSM and its impact on myocardial strain.Methods: 82 consecutive patients (mean age: 66 14 years, 36 male) presenting with acute ischemic stroke were consecutively included.LV functions of all patients were evaluated by two-dimensional (2D) speckle-tracking echocardiography.High-sensitive cardiac Troponin I (hs-cTnI) level>0.04ng/mL was accepted as increased.Results: 33 patients (40.2%) had elevated hs-cTnI and 23 patients (28%) had insular cortex involvement.The stroke patients with elevated hs-cTnI had higher frequencies of coronary artery disease and insular cortex involvement, higher NT-proBNP levels, and lower left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global and regional circumferential strain compared to patients with normal troponin levels.Although the patients with insular cortex involvement had significantly higher hs-cTnI levels, there were not any significant differences in LVEF and 2D-STE parameters between the groups.Conclusion: Elevated troponin levels may be associated with a decrease in LVEF and myocardial strain parameters, especially in acute ischemic stroke patients with insular cortex involvement; and may be considered as a sign of neurogenic myocardial stunning.