Page 41 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Cardiac dysfunction after aneurysmal subarachnoid hemorrhage: relationship with outcome
Introduction
Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) occurs at relatively
young age (mean age 55 years) and carries a poor prognosis: one third of patients die
within one month and of those who survive 10-15% remains dependent.1 Several
reports have described cardiac dysfunction following aSAH, and in a meta-analysis of
these studies we found that cardiac abnormalities are associated with poor outcome.2
However, it is uncertain whether this association is independent of known clinical
risk factors of poor outcome. An important prognosticator for outcome is delayed
cerebral ischemia (DCI).3 As cerebral autoregulation is disturbed after aSAH4,
impaired cardiac performance may lead to reduced cerebral blood flow (CBF), and 3 may contribute to the development of DCI.5
We conducted a prospective, multicenter cohort study to assess whether cardiac abnormalities independently influence the occurrence of DCI, death and poor outcome after aSAH.
Methods:
Design:
The study was designed as a prospective, observational, multicenter cohort study in the Netherlands. The number of patients to be included was 300, which was deemed to sufficiently answer the study objectives, based on the assumption that cardiac abnormalities would occur in 20% and DCI in 30%. With these assumptions an RR of 1.5 has a 95% confidence interval of 1.1 to 2.2. In a pre-specified interim analysis after 100 patients these assumptions were confirmed. From February 2005 to March 2008, 301 patients with aSAH were enrolled. Five tertiary referral university hospitals participated.
Standard Protocol Approvals, Registrations, and Patient Consents:
The study was approved by the national ethics committee and by all participating hospitals. Written informed consent was obtained from the patient or a legal representative.
Criteria for diagnosis of aSAH:
The diagnosis of aSAH was based on clinical signs and symptoms, presence of 39