Page 51 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Cardiac dysfunction after aneurysmal subarachnoid hemorrhage: relationship with outcome
output in combination with disturbed cerebral autoregulation after aSAH. However, since these analyses were not part of the original protocol and sample sizes were small, these observations need further explorations. Second, we did not have hemodynamic data to support cerebral hypoperfusion. Nevertheless, as DCI is a multifactorial entity, WMAs may play a role in the pathophysiology of DCI and may, if treated, improve outcome.
Some studies have suggested that ß-sympathicomometics such as dobutamine or phosphodiesterase inhibitors such as milrinone recruit inotropic reserve in patients
with aSAH.17, 33 The aforementioned drugs could be effective in restoring myocardial
function, but whether this improves outcome in patients with aSAH and WMA
should be investigated. 3 Our study included a high number of patients with poor clinical condition compared
to other studies. This might explain why we found a high proportion of patients with DCI. Another explanation for the relative high incidence of DCI lies in the criteria we used for DCI, including both clinical episodes not confirmed with new hypodensities on CT as well as any new hypodensity on CT. This definition has been proposed earlier.34 We found a high number of patients with a rebleed. This is probably due to the inclusion of a high number of patients in whom occlusion of the aneurysm was postponed because of poor clinical condition.
As this was an observational study we could only assess associations and neither pathophysiological pathways nor therapeutic hypotheses were evaluated.
The strength of the present study is the structured, prospective, and multicenter approach with a 90 day follow-up duration. We included a representative series of patients, including a considerable proportion of patients in poor clinical condition on admission.
Cardiac abnormalities occur frequently after aSAH. Echocardiographic WMAs are associated with clinical outcome after aSAH, regardless of the severity of the aSAH. This relation may partly be explained by a higher chance of DCI.
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