Page 85 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Myocarditis in patients with subarachnoid hemorrhage: a histopathological study
After this, consensus was achieved by the 2 observers. The number of extravascular inflammatory cells per 100 mm2 was then calculated. Myocytolysis was defined as Complement (C3d) positivity of cardiomyocytes. Finally, the number of putative thrombi (CD31 positive) in intramyocardial arteries was scored and calculated per 100 mm2. Myocarditis was classified according the Dallas criteria as “myocarditis”: an aggregation of inflammatory cells in the myocardium coincided with areas of myocytolysis, or “borderline myocarditis”: when aggregation of inflammatory cells in the myocardium was documented without myocytolysis.
Statistical analysis
Distribution of data was checked using Kolmogorov-Smirnoff analyses. After that, non-parametric testing using Mann-Whitney U was used for differences between groups. A sensitivity analysis was performed for patients with a proven aneurysm on autopsy and the patients with SAH without an aneurysm. A p-value <0.05 was considered statistically significant.
Results
Myocardial tissue samples of 25 patients were retrieved from the pathology databases.
Baseline characteristics could be retrieved for 23 patients. Mean age was 59(±SD15)
years of age, and 11 patients (44%) were female. In 16 patients (64%) a culprit
aneurysm was reported on autopsy. Duration from hospital admission to death
ranged from 2 hours to 21 days. As depicted in Figure 1, there was a large spread in 6 the number of cells per individual patient.
Myocardial tissue of 18 control patients was used as a control group. Figure 2 shows the mean number of cells in SAH patients compared to controls. Compared to the control group, the amount of MPO, CD45, and CD68 positive cells was significantly higher in SAH patients (p<0.005 for all).
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