Page 13 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

initial bleeding and complications such as rebleeding or delayed cerebral ischemia.
Apart from neurological complications, non-neurological complications occur after 1 aSAH, of which pulmonary and cardiac complications are the most important. To
further investigate the incidence and prognostic meaning of stress cardiomyopathy in
aSAH we launched a nationwide, multicenter, multidisciplinary cohort study called
Serial Echocardiography After SubArachnoid Hemorrhage (S.E.A.S.A.H.).
The study objectives were: first, to assess the incidence of cardiac abnormalities, defined as ECG changes, echocardiographic systolic and diastolic function abnormalities and cardiac specific enzyme and protein elevations in patients with aSAH. Second, to determine clinical variables that may predict the occurrence of cardiac abnormalities following aSAH. Third, to assess the impact of cardiac abnormalities on outcome at 3 months.
Patients who were admitted within 72 hours after an aSAH were eligible for inclusion in the study. An aneurysm had to be confirmed by angiography or CT angiography. On admission and at 4 and 8 days after onset of symptoms cardiac evaluation was performed using echocardiography, electrocardiography and blood sampling. Clinical parameters such as medical history, neurological condition on admission (Glasgow Coma Scale (GCS),19 World Federation of Neurosurgeons Score (WFNS),20 amount of blood on CT-scan (Hijdra score), medication, intracranial- (delayed cerebral ischemia, rebleeding, hydrocephalus) and extracranial- or systemic complications (pulmonary edema, pneumonia, cerebral salt wasting), and type of treatment (surgical or endovascular) were obtained. Finally, outcome at 3 months by means of the Glasgow Outcome Scale (GOS) 21 was assessed.
Transthoracic echocardiography was the standard examination. All echocardiographic examinations were performed according to the American Heart Association standards. The cross sections and the segments were recorded for off-line analysis. A minimum of three heart cycles was recorded. Two investigators (independent from each other and unaware from the clinical data of the patient) analyzed the echocardiogram for assessment of global and regional left ventricular function. Diastolic function was determined using E/A ratios and pulmonary vein flow.
All ECGs were analyzed by one investigator, who was unaware of the clinical data of the patient. Criteria for the ECG abnormalities were defined according to the
General Introduction
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