Page 57 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Time course and risk factors for myocardial dysfunction after aSAH
Introduction
Aneurysmal subarachnoid hemorrhage (aSAH) is a subset of stroke that occurs at young age (mean age 55 years), with an incidence of 5-20/100,000 and carries a poor prognosis: 30% of patients die within one month and of those who survive 10-15% remain dependent.1 In patients with aSAH, myocardial wall motion abnormalities (WMA) are associated with poor outcome, independently of other well-known clinical predictors.2-6 WMA are reported in up to 25% of patients and are usually reversible.7-10 To early identify patients at risk for poor outcome due to cardiac dysfunction, the objective of this study was to investigate the time course of WMA after aSAH and to identify predictors for WMA using clinical parameters, ECGs and myocardial serum markers that are available on admission.
Methods 4
Design:
The Serial Echocardiography After SubArachnoid Hemorrhage (SEASAH) study was a prospective multicenter cohort study conducted in 5 tertiary referral centers in the Netherlands. The study design was published earlier; the major finding of the study was that WMA are associated with poor outcome independent of other clinical parameters.6 Three hundred and one patients with aSAH were included. The Dutch national ethics committee and all local ethics committees of the participating hospitals approved the study. Written informed consent was obtained for all patients.
Criteria for diagnosis of aSAH:
The diagnosis of aSAH was based on clinical signs and symptoms, presence of 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 known electrocardiographic or echocardiographic abnormalities were excluded.
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