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. 2013;5(3):168-78.

Cardiac manifestations of subarachnoid hemorrhage

A Ahmadian  1 , A Mizzi  2 , M Banasiak  1 , K Downes  3 , E M Camporesi  4 , J Thompson Sullebarger  5 , R Vasan  1 , D Mangar  6 , H R van Loveren  1 , S Agazzi  1
Affiliations

Cardiac manifestations of subarachnoid hemorrhage

A Ahmadian et al. Heart Lung Vessel. 2013.

Abstract

Introduction: Cardiac manifestations of intracranial subarachnoid hemorrhage patients include mild electrocardiogram variability, reversible left ventricular dysfunction (Takotsubo), non-ST elevation myocardial infarction, ST-elevation myocardial infarction and cardiac arrest, but their clinical relevance is unclear. The aim of the present study was to categorize the relative frequency of different cardiac abnormalities in patients with subarachnoid hemorrhage and determine the influence of each abnormality on outcome.

Methods: A retrospective review of 617 consecutive patients who presented with non-traumatic aneurysmal subarachnoid hemorrhage at our institution was performed. A cohort of 87 (14.1%) patients who required concomitantly cardiological evaluation was selected for subgroup univariate and multi-variable analysis of radiographic, clinical and cardiac data.

Results: Cardiac complications included myocardial infarction arrhythmia and congestive heart failure in 47%, 63% and 31% of the patients respectively. The overall mortality of our cohort (23%) was similar to that of national inpatient databases. In our cohort a high World Federation of Neurosurgical Surgeons grading scale and a troponin level >1.0 mcg/L were associated with a 33 times and 10 times higher risk of death respectively.

Conclusions: Among patients suffering from cardiac events at the time of aneurysmal subarachnoid hemorrhage, those with myocardial infarction and in particular those with a troponin level greater than 1.0 mcg/L had a 10 times increased risk of death.

Keywords: MI; SAH; Takotsubo stress cardiomyopathy; arrhythmia; cardiac outcomes; intracranial aneurysm; myocardial Infarction; subarachnoid hemorrhage.

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Conflict of interest statement

Disclosures None declared.

Figures

Table 1
Table 1
Patient demographics and cardiac history.
Table 2
Table 2
Radiographic data.
Table 3
Table 3
Cardiovascular data.
Table 4
Table 4
Univariate mortality risk factors.
Table 5
Table 5
Univariate analysis of discharge status in 67 surviving patients.
Figure 1
Figure 1
Glascow Outcome Scale (GOS) GOS1: Dead, GOS 2 Vegetative State, GOS 3 Severe Disability (able to follow commands/ unable to live independently), GOS 4 Moderate Disability (able to live independently; unable to return to work or school), GOS 5 Good Recovery (able to return to work or school).
See this image and copyright information in PMC

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