QTc Interval Prolongation and Hemorrhagic Stroke: Any Difference Between Acute Spontaneous Intracerebral Hemorrhage and Acute Non-traumatic Subarachnoid Hemorrhage?

Abstract

Background:A variety of ECG changes occur as an aftermath of stroke. Prolongation of the QTc interval is a well-documented change. We analyzed QTc interval prolongation among patients with acute hemorrhagic strokes.Methods:This observational study was conducted at the Emergency Department of Sulaymaniyah General Teaching Hospital and Shar Hospital from September 1st, 2014 to August 31st, 2015. Fifty patients who developed acute spontaneous hypertensive intracerebral hemorrhage (ICH) and 50 patients who developed acute non-traumatic subarachnoid hemorrhage (SAH) were included in the study. All patients underwent resting 12-lead ECG within half an hour of admission. The QTc interval was calculated and analyzed in those 100 patients.Results:Females (62%) outnumbered males (38%) with a female to male ratio of 1.6:1. Forty percent of the patients were between 60-69 years of age. Hypertension was seen in 82% of patients while left ventricular hypertrophy was documented in 40% of patients. The QTc was prolonged in 38 patients (17 patients in the ICH group and 21 patients in the SAH group). In both groups, males demonstrated QTc prolongation more than females. However, there were no statistically significant gender difference between both groups and within the same group. There was a statistically significant association between SAH and QTc prolongation (p-value<0.001); the ICH group did not demonstrate any significant relationship with QTc prolongation.Conclusion:Prolongation in the QTc interval was “statistically” associated with acute SAH only. No gender difference was noted; whether this observation is clinically significant or not, it needs further analytic studies.

Relationship of QTc Interval Prolongation with Acute Ischemic Stroke

“…The autonomic and ECG changes following an acute stroke in patients without the underlying cardiac disease are common, well-thought-out because of the dysautonomic activity or disturbed autonomic regulation of the cardiovascular system (CVS). In addition to those complications, the sequelae are tremendously also common in subsequent strokes, which represent a major cause of mortality and morbidity ( 1 - 5 ). QTc prolongation is a good predictor of mortality ( 16 ).…”

“…The cardiovascular (CVS) complications are extremely common following stroke and represent a major form of morbidity and mortality to those patients ( 1 - 5 ). The relationship between heart and brain in the setting of acute stroke has been subjecting to debate for decades, in which several studies pointed out the relationship between acute cerebrovascular events and electrocardiographic (ECG) changes ( 2 , 6 - 10 ).…”

“…When the cardiac QTc interval prolongs, the myocardium becomes unstable and ventricular ectopic beats ensue, sometimes very frequently. The latter event can rapidly and unexpectedly degenerate into polymorphic ventricular tachycardia or even ventricular fibrillation, and finally sudden death ( 1 , 12 ).…”

Cardiac complications following cerebrovascular disease

“…Other research groups found similar frequencies of QTc-prolongations in patients with subarachnoid hemorrhage and HS. [26][27][28] However, the observation that QTc-prolongations were just as common in TIA patients as in IS patients is new. This and the fact that HS patients seem to be more prone to developing QT-prolongation than IS patients further indicates that long-term cardiac monitoring is warranted in all CVD patients.…”

QTC Prolongation in Patients of Haemorrhagic Stroke

“…WHO confirms that stroke is the second most common cause of death following coronary artery disease. 1 Unlike Western countries; its rate is inclining in South Asian population. In Pakistan, no large scale data is available showing the exact frequency of this disease.…”