Page 56 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Chapter 4
Abstract
Background: Myocardial wall motion abnormalities (WMA) are independent risk factors for poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).
Objective: To study the time course of WMA during the initial phase after aSAH, and to investigate which clinical, electrocardiographic or myocardial serum markers are predictors for early or late development of WMA.
Methods: In a prospective, multicenter cohort study in patients with aSAH we performed serial electrocardiography (ECG), echocardiography, and measured Troponin T and NT-proBNP. WMA present on admission were considered early WMA; those that developed during the clinical course were considered late WMA. With multivariable regression analysis we calculated odds ratios (OR) with corresponding 95% confidence intervals (CI) for clinical parameters, ECG, and myocardial serum makers with early or late occurrence of WMA.
Results: We included 301 patients (mean age 57(SD±13) years). Multivariable ORs for early WMA were: poor clinical condition 2.7(95%CI: 1.1-6.8), sinus tachycardia 5.0(1.3-19.9), ST-depression 3.7(1.02-13.1), ST-elevation 16.6 (1.5-178.9) and elevated troponin T 2.8(1.1-7.3). Multivariable ORs for late development of WMA were 6.8 (1.6-30) for myocardial infarct pattern on admission ECG and 3.4 (1.4-8.5) for elevated troponin T on admission.
Conclusions: WMA may be present on admission or develop during the course of aSAH. Poor neurological condition on admission, sinus tachycardia, ST-depression and ST-elevation at the admission ECG and elevated troponin T, are independent predictors for early WMA, a myocardial infarct pattern on the admission ECG and elevated troponin T independently predict late WMA.
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