Page 40 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Chapter 3
Abstract
Objective: To assess whether cardiac abnormalities after aneurysmal subarachnoid hemorrhage (aSAH) are associated with delayed cerebral ischemia and clinical outcome, independent from known clinical risk factors for these outcomes. Methods: In a prospective, multicenter cohort study we performed echocardiography, electrocardiography (ECG) and measured biochemical markers for myocardial damage in patients with aSAH. Outcomes were delayed cerebral ischemia (DCI), death and poor clinical outcome (death or dependency for activities of daily life) at three months. With multivariable Poisson regression analysis we calculated risk ratios (RR) with corresponding 95% confidence intervals (CI). We used survival analysis to assess cumulative percentage of death in patients with and without echocardiographic wall motion abnormalities (WMAs).
Results: We included 301 patients with a mean age of 57 years. 70% were women. A wall motion score index ≥ 1.2 had an adjusted RR 1.2(0.9-1.6) for DCI, 1.9(1.1-3.3) for death and 1.8(1.1-3.0) for poor outcome. Midventricular WMAs had adjusted RRs 1.1(0.8-1.4) for DCI, 2.3(1.4-3.8) for death and 2.2(1.4-3.5) for poor outcome. For apical WMAs adjusted RRs were 1.3(1.1-1.7) for DCI, 1.5(0.8-2.7) for death and 1.4(0.8-2.5) for poor outcome. Elevated Troponin T levels, ST-segment changes and low voltage on the admission ECGs had a univariable association with death, but were no independent predictors for outcome.
Conclusion: WMAs are independent risk factors for clinical outcome after aSAH. This relation is partly explained by a higher risk of DCI. Further study should aim at treatment strategies for these aSAH related cardiac abnormalities to improve clinical outcome.
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