Page 112 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Summary
Aneurysmal subarachnoid hemorrhage (aSAH), caused by rupture of an intracranial aneurysm, is a devastating neurological disease that accounts for approximately 5% of all strokes. It occurs at a relative young age (50% of patients are younger than 55 years of age), women are predominantly affected and prognosis is poor. Treatment is based primarily on aneurysm obliteration by either coiling or clipping of the aneurysm, the latter requiring craniotomy. However, during the course of the aSAH several neurological and medical complications may occur. The most important neurological complications are rebleeding of the aneurysm, hydrocephalus and delayed cerebral ischemia. Other complications are cardiac dysfunction, pulmonary dysfunction and renal dysfunction. Other common complications of a general Intensive Care Unit population such as infection, SIRS, etc. of course might also threaten this vulnerable patient group.
Of the non-neurological complications after aSAH, cardiac complications occur rather frequently and treatment options are unclear. Stress cardiomyopathy or Tako- tsubo cardiomyopathy is a fascinating phenomenon that has been described after acute stress. It is a reversible cardiac dysfunction with distinct imaging features (the echocardiographic or left ventricular angiographic image resembles a Tako-Tsubo which is a Japanese octopus trap) that is also observed after aSAH. Additionally, ECG abnormalities and biochemical changes occur. This thesis was based on the question how often cardiac dysfunction occurs in aSAH, what the clinical characteristics are and whether it influences outcome. Second we sought to further investigate Tako- Tsubo cardiomyopathy in a disease where it seemed to occur often: aSAH.
We designed a multicenter cohort study (Serial Echocardiography After Subarachnoid Hemorrhage (S.E.A.S.A.H.)) to observe the frequency of cardiac dysfunction, characteristics of the cardiac dysfunction and to investigate prognostic meaning in patients with aSAH.
In Chapter 1 the outline of this thesis is described with an introduction and background. Furthermore we elaborate on the study design of the SEASAH study and explain the study protocol. The SEASAH was a multicenter cohort study in which serial ECG’s, echocardiography and laboratory testing was performed in patients with aSAH. A follow-up took place at 3 months. Outcome was defined as death, occurrence of delayed cerebral ischemia (DCI) or poor functional status.
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