Time Course and Risk Factors for Myocardial Dysfunction After Aneurysmal Subarachnoid Hemorrhage

Ivo A. van der Bilt*, Djo Hasan, Renee B. van den Brink, Maarten J. Cramer, Mathieu van der Jagt, Fop van kooten, Joost G. Regtien, Maarten P. van den berg, Rob J. Groen, Folkert J. ten Cate, Otto Kamp, Marco J. Gotte, Janneke Horn, Armand R. Girbes, W. Peter Vandertop, Ale Algra, Gabriel J. Rinkel, Arthur A. Wilde, SEASAH Serial Echocardiography Sub

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

9 Citaten (Scopus)

Samenvatting

BACKGROUND: Myocardial wall motion abnormalities (WMAs) are independent risk factors for a poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).

OBJECTIVE: To study the time course of WMAs during the initial phase after aSAH and to investigate which clinical, electrocardiographic, or myocardial serum markers are predictors of early or late development of WMAs.

METHODS: In a prospective, multicenter cohort study in patients with aSAH, we performed serial electrocardiography and echocardiography and measured troponin T and N-terminal pro-B-type natriuretic peptide. WMAs present on admission were considered early WMAs; those that developed during the clinical course were considered late WMAs. Using multivariable regression analysis, we calculated odds ratios with corresponding 95% confidence intervals for clinical parameters, electrocardiography, and myocardial serum makers with early or late occurrence of WMAs.

RESULTS: We included 301 patients (mean age +/- SD, 57 +/- 13) years. Multivariable odds ratios for early WMAs were poor clinical condition, 2.7 (95% confidence interval: 1.1-6.8); sinus tachycardia, 5.0 (1.3-19.9); ST-segment depression, 3.7 (1.02-13.1); ST-segment elevation, 16.6 (1.5-178.9); and increased troponin T, 2.8 (1.1-7.3). Multivariable odds ratios (95% confidence intervals) for late development of WMAs were 6.8 (1.6-30) for a myocardial infarct pattern on admission electrocardiography and 3.4 (1.4-8.5) for increased troponin T on admission.

CONCLUSION: WMAs may be present on admission or develop during the course of aSAH. Poor neurological condition on admission, sinus tachycardia, ST-segment depression, and ST-segment elevation on admission electrocardiography and increased troponin T are independent predictors of early WMAs; a myocardial infarct pattern on admission ECG and increased troponin T independently predict late WMAs.

Originele taal-2English
Pagina's (van-tot)700-706
Aantal pagina's7
TijdschriftNeurosurgery
Volume76
Nummer van het tijdschrift6
Vroegere onlinedatum14-feb-2015
DOI's
StatusPublished - jun-2015

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