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Abstract
Objective: To assess whether cardiac abnormalities after aneurysmal subarachnoid hemorrhage (aSAH) are associated with delayed cerebral ischemia (DCI) and clinical outcome, independent from known clinical risk factors for these outcomes.
Methods: In a prospective, multicenter cohort study, we performed echocardiography and ECG and measured biochemical markers for myocardial damage in patients with aSAH. Outcomes were DCI, death, and poor clinical outcome (death or dependency for activities of daily living) at 3 months. With multivariable Poisson regression analysis, we calculated risk ratios (RRs) with corresponding 95% confidence intervals. We used survival analysis to assess cumulative percentage of death in patients with and without echocardiographic wall motion abnormalities (WMAs).
Results: We included 301 patients with a mean age of 57 years; 70% were women. A wall motion score index ≥1.2 had an adjusted RR of 1.2 (0.9–1.6) for DCI, 1.9 (1.1–3.3) for death, and 1.8 (1.1–3.0) for poor outcome. Midventricular WMAs had adjusted RRs of 1.1 (0.8–1.4) for DCI, 2.3 (1.4–3.8) for death, and 2.2 (1.4–3.5) for poor outcome. For apical WMAs, adjusted RRs were 1.3 (1.1–1.7) for DCI, 1.5 (0.8–2.7) for death, and 1.4 (0.8–2.5) for poor outcome. Elevated troponin T levels, ST-segment changes, and low voltage on the admission ECGs had a univariable association with death but were not independent predictors for outcome.
Conclusion: WMAs are independent risk factors for clinical outcome after aSAH. This relation is partly explained by a higher risk of DCI. Further study should aim at treatment strategies for these aSAH-related cardiac abnormalities to improve clinical outcome.
GLOSSARY
- aSAH=
- aneurysmal subarachnoid hemorrhage;
- DCI=
- delayed cerebral ischemia;
- IQR=
- interquartile range;
- mRS=
- modified Rankin Scale;
- NT-proBNP=
- N-terminal prohormone of B-type natriuretic peptide;
- RR=
- risk ratio;
- TTC=
- takotsubo cardiomyopathy;
- WMA=
- wall motion abnormality;
- WMSI=
- wall motion score index
Footnotes
SEASAH coinvestigators are listed on the Neurology® Web site at www.neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received May 21, 2013.
- Accepted in final form October 18, 2013.
- © 2014 American Academy of Neurology
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