Relation of ECG changes to neurological outcome in patients with aneurysmal subarachnoid hemorrhage

Sakr, Yasser; Lim, Noelle; Amaral, Andre Carlos Kajdacsy-Balla; Ghosn, Issam; Carvalho, Frederico Bruzzi de; Renard, Marc; Vincent, Jean‐Louis

doi:10.1016/j.ijcard.2003.07.027

Cited by 87 publications

(57 citation statements)

References 18 publications

(15 reference statements)

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“…Brouwers, et al 26) reported that ECG abnormalities were related to the neurological status at admission and to outcome. Sakr, et al, 7) however, reported that none of the ECG abnormalities was an independent predictor of mortality in a retrospective study with 159 SAH patients. Recently, Kawasaki,et al 22) have demonstrated the prognostic value of an ECG score that is the sum of the number of leads that have a pathological Q-wave, ST-depression, and/or T-wave inversion.…”

Section: Ecg Abnormalities In Sahmentioning

confidence: 96%

“…Therefore, early identification and monitoring of cardiac dysfunction is a critical issue. ECG abnormalities have been reported frequently in the course of SAH, [4][5][6][7]21,22) whereas the relation of ECG abnormalities to mortality has not been extensively studied. 4,7,22) Echocardiography is a more accurate method with which to assess cardiac function, however, little published data exist on the prognostic value of LV dysfunction observed shortly after SAH.…”

mentioning

confidence: 99%

“…ECG abnormalities have been reported frequently in the course of SAH, [4][5][6][7]21,22) whereas the relation of ECG abnormalities to mortality has not been extensively studied. 4,7,22) Echocardiography is a more accurate method with which to assess cardiac function, however, little published data exist on the prognostic value of LV dysfunction observed shortly after SAH. 12,13) The aim of the present study was to evaluate the prognostic value of global (LV ejection fraction [EF]) and segmental (regional wall motion abnormality [RWMA]) LV dysfunction, as compared with ECG abnormalities and neurological status.…”

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confidence: 99%

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Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

et al. 2008

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SUMMARYLeft ventricular (LV) dysfunction generally occurs early in the course of subarachnoid hemorrhage (SAH). We evaluated the prognostic value of electrocardiographic (ECG) abnormalities and echocardiographic LV dysfunction evaluated shortly after SAH.We prospectively enrolled 47 SAH patients (62 ± 14 years, mean ± SD) who were admitted to the neurosurgical care unit of our institute. Neurological status was rated on the day of admission. Twelve-lead ECG and 2-dimensional echocardiography were recorded 2 ± 1 day after onset of SAH. ECG abnormalities (pathological Q-wave, ST-segment deviation, T-wave inversion, and QT prolongation) were evaluated and the incidences of global (LV ejection fraction < 50%) and segmental (regional wall motion abnormality [RWMA]) LV dysfunction were measured.During a follow-up period of 44 ± 23 days, 17 (36%) patients died. ECG abnormalities, LV ejection fraction < 50%, and RWMA were observed in 62%, 11%, and 28% of patients, respectively. Univariate Cox proportional hazards regression analysis revealed that neurological status, rate-corrected QT interval, LV ejection fraction, and RWMA were significant predictors of death. After adjustment for these significant clinical variables, and age and sex, independent predictors of mortality were neurological status and RWMA.RWMA may provide significant prognostic information in patients with SAH. (Int Heart J 2008; 49: 75-85)

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Section: Ecg Abnormalities In Sahmentioning

confidence: 96%

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confidence: 99%

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confidence: 99%

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Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

et al. 2008

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“…QTc prolongation is observed most frequently, i.e. in about 45−71% of patients with subarachnoid haemorrhage, 64% of those with intracranial haemorrhage and 38% of individuals with cerebral stroke [3,19], and is associated with an increased risk of severe ventricular arrhythmias. The ECG changes develop early and are correlated with the severity of the neurologic injury and precede the clinical symptoms of arrhythmias.…”

Section: Epidemiology and Clinical Picturementioning

confidence: 99%

“…the inotropic use of insulin [8]. Recently, the cases of effective NSM treatment with the infusion of insulin have been described [18,19]. Moreover, some patients can benefit from the use of intra-aortal balloon counterpulsation [9].…”

Section: Treatmentmentioning

confidence: 99%

Ogłuszone serce neurogenne — czy uwzględniamy to rozpoznanie u chorych z ostrym uszkodzeniem ośrodkowego układu nerwowego i niewydolnością serca?

Mierzewska-Schmidt

Gawecka²

2015

Anaesthesiol Intensive Ther

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Neurogenic stunned myocardium (NSM) is defined as myocardial injury and dysfunction of a sudden onset, occurring after various types of acute brain injury as a result of an imbalance in the autonomic nervous system. The typical spectrum of clinically observed abnormalities includes acute left ventricular failure, not uncommonly progressing to cardiogenic shock with hypotension that requires inotropic agents, pulmonary oedema and various arrhythmias. Commonly-seen electrocardiographic changes include: prolonged QT interval, ST segment changes, T-wave inversion, a new Q-wave or U-wave. Echocardiography shows both an impaired both systolic and diastolic function of the left ventricle. Biochemical markers of NSM comprise metabolic acidosis and increased cardiac enzymes and markers: creatine kinase (CK), and CK-MB, troponin I and B-type natriuretic peptide. The main cause of NSM is myocardial injury induced by local catecholamine release from nerve endings within the myocardium. Recently, a theory has been proposed to classify NSM as one of the stress-related cardiomyopathies, together with Takotsubo cardiomyopathy, acute left ventricular failure in the critically ill, cardiomyopathy associated with pheochromacytoma and exogenous catecholamine administration. The occurrence of NSM increases the risk of life-threatening complications, death, and worsens neurologic outcome. As far as we know, treatment should generally focus on the underlying neurologic process in order to maximize neurologic recovery. Improvement in neurologic pathology leads to rapid improvement in cardiac function and its full recovery, as NSM is a fully reversible condition if the patient survives. Awareness of the existence of NSM and a deeper knowledge of its etiopathology may reduce diagnostic errors, optimise its treatment.

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Neurosurgery

Ryan

Ajam

Thompson

2012

Perioperative Medicine

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Relation of ECG changes to neurological outcome in patients with aneurysmal subarachnoid hemorrhage

Cited by 87 publications

References 18 publications

Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

Prognostic Implications of Left Ventricular Wall Motion Abnormalities Associated With Subarachnoid Hemorrhage

Ogłuszone serce neurogenne — czy uwzględniamy to rozpoznanie u chorych z ostrym uszkodzeniem ośrodkowego układu nerwowego i niewydolnością serca?

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