Page 113 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

In Chapter 2 the results of our meta-analysis are presented which we performed prior to conducting the SEASAH study. From this meta-analysis on literature from 1960-2007 we included 25 studies with a total of 2690 patients. We concluded that troponin and/or NT-proBNP and abnormal echocardiographic findings are associated with an increased risk of death, poor outcome, and delayed cerebral ischemia after subarachnoid hemorrhage (relative risk for death and wall motion abnormalities on echocardiography was 1.9). However, multi-variate analysis was not possible and many questions remained. So we decided to go forward with the SEASAH study.
In Chapter 3 we describe the results of the SEASAH study. In this study we included 301 patients in which we performed serial ECGs, echocardiography and measured troponin and NT-proBNP. We performed a 3 months follow up for death, occurrence of DCI and poor outcome. We found that echocardiographic wall motion abnormalities were associated with death, DCI and poor outcome, independent of other clinical predictors for outcome. This finding was in line with the meta-analysis but answered the important question whether wall motion abnormalities were independent predictor for poor outcome. We also found that elevated troponin T levels, ST-segment changes, and low voltage on the admission ECGs had a univariable association with death but were not independent predictors for outcome.
In Chapter 4 a sub-analysis of the SEASAH is described. Because of the reversible nature of the wall motion abnormalities we wanted to investigate the time course of WMA during the initial phase after aSAH. Furthermore we investigated which clinical, electrocardiographic or myocardial serum markers are predictors for early or late development of WMA. We found that WMA may be present on admission or develop during the course of aSAH. Poor neurological condition on admission, sinus tachycardia, ST-depression and ST-elevation at the admission ECG and elevated troponin T, are independent predictors for early WMA, a myocardial infarct pattern on the admission ECG and elevated troponin T in patients with aSAH predict late WMA independent of other clinical predictors.
In Chapter 5 we investigated our hypothesis that cardiac dysfunction impairs cerebral perfusion and thus influences outcome. Data of cerebral CT perfusion was correlated with cardiac data from the SEASAH. We found an association between decreased cerebral blood flow in patients with impaired cardiac function compared
Summary
111