Page 46 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Chapter 3
admission. Subanalyses were performed for patients that underwent the investigations within 48 hours of the bleed, for patients that underwent surgery or coiling and for the outcomes definite DCI, and probable and definite DCI combined.
Results
Participants:
320 patients were assessed for eligibility. Five patients were not included because no aneurysm was found; for 5 others informed consent was declined by next of kin. Nine were excluded: in 6 no cardiac examination could be performed and 3 were lost to follow-up. Finally, 301 subjects completed follow-up and were analyzed. Baseline characteristics are listed in table 1.
Cardiac data:
The prevalence of cardiac abnormalities on admission is shown in table 2.
The wall motion abnormalities did not correspond to a single coronary territory. Ten percent of patients showed hypokinesia of the apical segments with hypercontractility of the basal segments which is compatible with a Takotsubo cardiomyopathy (TTC).14Due to this finding, a secondary analysis was done to analyze whether WMAs occurring in the basal, midventricular or apical segments were as such associated with outcome.
Outcome data:
Probable or definite ischemia occurred in 164(54%) patients. Of these patients 146(48%) had definite DCI. The median time from aSAH onset to DCI was 3.5; IQR 4.9 days. At the end of follow up 58(19%) patients had died (median time to death 10; IQR days) and 66(22%) had a poor outcome (8 patients had MRS 4 or 5). In 57 patients cause of death was poor neurological condition, and one patient died due to cardiogenic shock. Post mortem examination in the latter patient showed a rupture of the free wall of the right ventricle and thrombotic occlusion of the right coronary artery. During the clinical course 40(16%) patients had an episode of rebleeding. Median time to rebleeding was 3.6; IQR 10.1 days. 48(51%) of patients that underwent clipping had surgery within 24 hours. 121(66%) of patients that underwent coiling had it within 24 hours. Results were essentially the same if we restricted the analyses to patients investigated within 48 hours after onset of clinical symptoms.
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