Page 42 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Chapter 3
subarachnoid blood on computer tomography (CT) scan or xanthochromia of the cerebrospinal fluid if the CT was non-diagnostic, and by the presence of an aneurysm on conventional or CT-angiography. Patients with aSAH presenting within 72 hours of the onset of symptoms were eligible for inclusion. Patients with cardiac abnormalities prior to the aSAH (i.e. ECG or echocardiographic abnormalities after myocardial infarction, CABG or PCI) were excluded. All investigations mentioned below were performed within 24 hours after admission.
Study procedure and data collection:
Clinical data were entered in case report forms (CRF) by local investigators. Periodically, the study coordinator (IB) checked all CRFs against patients’ charts and entered these in an anonymized electronic database. The following data were collected: age, sex, loss of consciousness at ictus, seizures at ictus, angina pectoris, myocardial infarction, prior coronary artery bypass graft (CABG), prior angioplasty, known hypertension, hypercholesterolemia, peripheral vascular disease, cerebrovascular events (ischemic or hemorrhagic), diabetes mellitus, current cigarette smoking, family history of coronary artery disease, drug use. The clinical condition on admission was categorized according to the World Federation of Neurosurgical Societies (WFNS) grading scale for subarachnoid hemorrhage, where a WFNS ≥ 3 was considered a poor condition on admission.6
CT-scan:
The amount of blood on all admission CT scans was assessed according to the Hijdra score7 by one investigator (DH), who was unaware of the clinical condition of the patient. The amount of blood in 13 cerebral cisterns was scored from 0 (no blood) to 2 (completely filled with blood). The sum score (ranging from 0 to 26) for each CT scan was calculated.
Electrocardiography:
All ECGs were analyzed by one investigator (FV), who was unaware of the clinical data of the patient. Criteria for the ECG abnormalities were defined according to the guidelines of the European Society of Cardiology (ESC).8 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.
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