Page 14 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Chapter 1
guidelines of the European Society of Cardiology. A Q-wave in two contiguous leads was considered pathological when ≥ 0.03s wide and ≥ 0.1mV deep. ST deviation was considered to represent myocardial ischemia when ST elevation occurred at the J-point in two contiguous leads with the cut-off points: ≥0.2 mV in men or ≥ 0.15 mV in women in leads V2–V3 and/or ≥ 0.1 mV in other leads. Horizontal or down- sloping ST depression ≥ 0.05 mV in two contiguous leads; and/or T inversion ≥ 0.1 mV in two contiguous leads with prominent R-wave or R/S ratio >1 were also considered ischemic changes. The Cornell voltage criteria (RaVL+SV3 > 28 mm (men) or > 20 mm (women)), or Sokolow-Lyon voltage index (SV1+RV5/6) >35 mm for left ventricular hypertrophy were used.
The diagnostic brain CT-scan was used for analysis. The amount of blood in 13 individual cerebral cisterns on each CT was scored: a score of 0 = no blood; 1 = cistern partially filled with blood; and 2 = completely filled with blood. Subsequently, the sum score (ranging from 0 to 26) for each CT was calculated. A sum score greater than 13 was regarded as a “high cisternal blood score”.
A neurological examination was conducted on admission, on a daily basis, and after every deterioration of clinical condition. The level of consciousness was assessed by means of the 15-point Glasgow Coma Scale.
Prognosis was defined as death or dependency using the GOS. The follow-up period was defined as the time interval between entering the study and 3 month after onset of the aSAH.
Before we conducted the SEASAH study, we first performed a meta-analysis of the available literature from 1960 to 2007 regarding cardiac dysfunction after aneurysmal subarachnoid hemorrhage. This meta-analysis can be found in Chapter 2 of this thesis. As most of the included studies were of small sample size, different study design and retrospective, questions remained. Therefore, in Chapter 3 we describe the results of the SEASAH study. In this chapter we describe the incidence and prognostic significance of cardiac abnormalities after aSAH. In Chapter 4 we describe the time course and risk factors of the myocardial dysfunction after aSAH. We found that WMA may be present on admission or develop during the course of aSAH. In Chapter 5 we describe a study where we found that aSAH patients with cardiac dysfunction have an impaired cerebral perfusion measured with perfusion CT. This
12