{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T10:27:01Z","timestamp":1771410421895,"version":"3.50.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      311 patients were included; 13 (4.2%) had a TCM diagnosis. Median TCM diagnosis day was post-bleed day 4 (IQR 2\u20135). High-grade rupture (Hunt Hess score\u2009\u2265\u20093) was associated with TCM (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). Vasopressor use after aneurysm securement was associated with TCM (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). 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\u201361.952,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.287).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this sample of aSAH patients, a majority of TCM diagnoses were made within 5\u00a0days 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-026-06795-6","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T07:59:52Z","timestamp":1771315192000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pressor use and its impact on outcomes in aneurysmal subarachnoid hemorrhage patients with takotsubo cardiomyopathy: a quantitative analysis"],"prefix":"10.1007","volume":"168","author":[{"given":"Varun S.","family":"Shah","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Lacanienta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orlando","family":"Martinez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Frances","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quang","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adel","family":"Azghadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Collin M.","family":"Labak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Michas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoey","family":"Knox","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"Will","family":"Casto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa","family":"Antuna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaofei","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Bates","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"III","given":"David L.","family":"Dornbos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhishek","family":"Ray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin C.","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"6795_CR1","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1016\/j.ijcard.2014.07.279","volume":"176","author":"TT Abd","year":"2014","unstructured":"Abd TT, Hayek S, Cheng JW et al (2014) Incidence and clinical characteristics of takotsubo cardiomyopathy post-aneurysmal subarachnoid hemorrhage. Int J Cardiol 176:1362\u20131364","journal-title":"Int J Cardiol"},{"key":"6795_CR2","first-page":"1","volume":"4","author":"JS Catapano","year":"2020","unstructured":"Catapano JS, Ducruet AF, Frisoli FA et al (2020) Predictors of the development of takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage and outcomes in patients with intra-aortic balloon pumps. J Neurosurg Sept 4:1\u20136","journal-title":"J Neurosurg Sept"},{"key":"6795_CR3","doi-asserted-by":"publisher","first-page":"e347","DOI":"10.1016\/j.wneu.2012.05.029","volume":"80","author":"AF Ducruet","year":"2013","unstructured":"Ducruet AF, Albuquerque FC, Crowley RW, Williamson R, Forseth J, McDougall CG (2013) Balloon-pump counterpulsation for management of severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage. World Neurosurg 80:e347\u2013e352","journal-title":"World Neurosurg"},{"key":"6795_CR4","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1536\/ihj.21-391","volume":"3","author":"T Fujita","year":"2022","unstructured":"Fujita T, Nakaoka Y, Hayashi S et al (2022) Incidence and clinical characteristics of Takotsubo syndrome in patients with subarachnoid hemorrhage. Int Heart J 3:517\u2013523","journal-title":"Int Heart J"},{"key":"6795_CR5","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1007\/s00701-016-2768-6","volume":"158","author":"J Inamasu","year":"2016","unstructured":"Inamasu J, Ganaha T, Nakae S et al (2016) Therapeutic outcomes for patients with aneurysmal subarachnoid hemorrhage complicated by Takotsubo cardiomyopathy. Acta Neurochir (Wien) 158:885\u2013893","journal-title":"Acta Neurochir (Wien)"},{"key":"6795_CR6","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.echo.2004.08.045","volume":"18","author":"K Khush","year":"2005","unstructured":"Khush K, Kopelnik A, Tung P et al (2005) Age and aneurysm position predict patterns of left ventricular dysfunction after subarachnoid hemorrhage. J Am Soc Echocardiogr 18:168\u2013174","journal-title":"J Am Soc Echocardiogr"},{"key":"6795_CR7","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1177\/1074248417708618","volume":"22","author":"K Kido","year":"2017","unstructured":"Kido K, Guglin M (2017) Drug-Induced Takotsubo Cardiomyopathy. J Cardiovasc Pharmacol Ther 22:552\u2013563","journal-title":"J Cardiovasc Pharmacol Ther"},{"key":"6795_CR8","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.clineuro.2014.10.017","volume":"128","author":"KJ Kilbourn","year":"2015","unstructured":"Kilbourn KJ, Ching G, Silverman DI, McCullough L, Brown RJ (2015) Clinical outcomes after neurogenic stress induced cardiomyopathy in aneurysmal sub-arachnoid hemorrhage: a prospective cohort study. Clin Neurol Neurosurg 128:4\u20139","journal-title":"Clin Neurol Neurosurg"},{"key":"6795_CR9","doi-asserted-by":"publisher","first-page":"602","DOI":"10.4330\/wjc.v6.i7.602","volume":"6","author":"K Komamura","year":"2014","unstructured":"Komamura K, Fukui M, Iwasaku T et al (2014) Takotsubo cardiomyopathy: pathophysiology, diagnosis and treatment. World J Cardiol 6:602\u2013609","journal-title":"World J Cardiol"},{"key":"6795_CR10","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s13054-023-04322-y","volume":"27","author":"Y Kotani","year":"2023","unstructured":"Kotani Y, Di Gioia A, Landoni G et al (2023) An updated \u201cnorepinephrine equivalent\u201d score in intensive care as a marker of shock severity. Crit Care 27:29","journal-title":"Crit Care"},{"key":"6795_CR11","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1186\/s13054-015-1036-0","volume":"19","author":"H Lantigua","year":"2015","unstructured":"Lantigua H, Ortega-Gutierrez S, Schmidt JM et al (2015) Subarachnoid hemorrhage: who dies, and why? Crit Care 19:309","journal-title":"Crit Care"},{"key":"6795_CR12","doi-asserted-by":"publisher","first-page":"264","DOI":"10.3171\/jns.2006.105.2.264","volume":"105","author":"VH Lee","year":"2006","unstructured":"Lee VH, Connolly HM, Fulgham JR, Manno EM, Brown JRD, Wijdicks EF (2006) Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction. J Neurosurg 105:264\u2013270","journal-title":"J Neurosurg"},{"key":"6795_CR13","doi-asserted-by":"publisher","first-page":"889","DOI":"10.3171\/jns.1995.83.5.0889","volume":"83","author":"SA Mayer","year":"1995","unstructured":"Mayer SA, LiMandri G, Sherman D et al (1995) Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage. J Neurosurg 83:889\u2013896","journal-title":"J Neurosurg"},{"key":"6795_CR14","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1007\/s12028-017-0412-9","volume":"27","author":"DM Nasr","year":"2017","unstructured":"Nasr DM, Tomasini S, Prasad A, Rabinstein AA (2017) Acute brain diseases as triggers for stress cardiomyopathy: clinical characteristics and outcomes. Neurocrit Care 27:356\u2013361","journal-title":"Neurocrit Care"},{"key":"6795_CR15","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1007\/s12028-018-0558-0","volume":"29","author":"E Norberg","year":"2018","unstructured":"Norberg E, Odenstedt-Herges H, Rydenhag B, Oras J (2018) Impact of acute cardiac complications after subarachnoid hemorrhage on long-term mortality and cardiovascular events. Neurocrit Care 29:404\u2013412","journal-title":"Neurocrit Care"},{"key":"6795_CR16","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1161\/STROKEAHA.117.019328","volume":"49","author":"MN Stienen","year":"2018","unstructured":"Stienen MN, Germans M, Burkhardt JK et al (2018) Predictors of in-hospital death after aneurysmal subarachnoid hemorrhage: analysis of a nationwide database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]). Stroke 49:333\u2013340","journal-title":"Stroke"},{"key":"6795_CR17","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.clineuro.2015.12.005","volume":"141","author":"M Talahma","year":"2016","unstructured":"Talahma M, Alkhachroum AM, Alyahya M, Manjila S, Xiong W (2016) Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: institutional experience and literature review. Clin Neurol Neurosurg 141:65\u201370","journal-title":"Clin Neurol Neurosurg"},{"key":"6795_CR18","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1007\/s12028-010-9447-x","volume":"13","author":"RE Temes","year":"2010","unstructured":"Temes RE, Tessitore E, Schmidt JM et al (2010) Left ventricular dysfunction and cerebral infarction from vasospasm after subarachnoid hemorrhage. Neurocrit Care 13:359\u2013365","journal-title":"Neurocrit Care"},{"key":"6795_CR19","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1056\/NEJMoa1406761","volume":"373","author":"C Templin","year":"2015","unstructured":"Templin C, Ghadri JR, Diekmann J et al (2015) Clinical features and outcomes of Takotsubo cardiomyopathy. N Engl J Med 373:929\u2013938","journal-title":"N Engl J Med"},{"key":"6795_CR20","doi-asserted-by":"publisher","first-page":"S273","DOI":"10.1097\/01.ccm.0001000576.00635.bd","volume":"52","author":"V Thiagarajan","year":"2024","unstructured":"Thiagarajan V, Daniels J (2024) Cardiac arrest with verapamil use in ASAH vasospasm treatment. Crit Care Med 52:S273","journal-title":"Crit Care Med"},{"key":"6795_CR21","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.31083\/j.rcm2204132","volume":"22","author":"S Wagner","year":"2021","unstructured":"Wagner S, G\u00fcthe T, Bhogal P et al (2021) Aneurysmal subarachnoid hemorrhage as a trigger for Takotsubo syndrome: a comprehensive review. Rev Cardiovasc Med 22:1241\u20131251","journal-title":"Rev Cardiovasc Med"},{"key":"6795_CR22","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1067\/mje.2000.105763","volume":"13","author":"JG Zaroff","year":"2005","unstructured":"Zaroff JG, Rordorf GA, Ogilvy CS, Picard MH (2005) Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neurally mediated cardiac injury. J Am Soc Echocardiogr 13:774\u2013779","journal-title":"J Am Soc Echocardiogr"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-026-06795-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-026-06795-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-026-06795-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T09:58:51Z","timestamp":1771408731000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-026-06795-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6795"],"URL":"https:\/\/doi.org\/10.1007\/s00701-026-06795-6","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]},"assertion":[{"value":"19 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective study was approved by the Institutional Review Board (IRB STUDY20191604) at two academic tertiary-care institutions. The names of the boards are University Hospitals Cleveland Medical Center IRB and University of Kentucky Medical Center IRB. This study adheres to ethical guidelines as defined in the 1964 Declaration of Helsinki and its later amendments. Due to the retrospective nature of this study the IRB at both above institutions deemed patient consent was not needed to conduct this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"38"}}