Electrocardiographic Changes Predict Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose-Early identification of patients at risk of angiographic vasospasm after aneurysmal subarachnoid hemorrhage (SAH) may mitigate its sequelae. One mechanism that may contribute to angiographic vasospasm is increased central sympathetic activity, which is also thought to cause electrocardiographic (ECG) changes after SAH. Here, we perform the first study to determine the association between ECG changes and angiographic vasospasm after SAH. Methods-Exploratory analysis was performed on 413 patients from CONSCIOUS-1, a prospective randomized trial of clazosentan for the prevention of angiographic vasospasm. ECGs were obtained within 24 hours of aneurysm rupture and during the vasospasm risk period. Angiographic vasospasm was assessed using catheter angiography at baseline and 7 to 11 days after SAH. Multivariate logistic regression was used to identify significant associations. Results-The most prevalent finding on ECG both immediately following SAH and during the vasospasm risk period was QT prolongation (42% and 25%, respectively). A prolonged QT interval and tachycardia on the baseline ECG were associated with angiographic vasospasm (OR, 1.86; 95% CI, 1.00 -3.45; and OR, 10.83; 95% CI, 1.17-100.50, respectively). QT prolongation on ECG during the vasospasm risk period was also associated with angiographic vasospasm (OR, 3.53; 95% CI,. No ECG findings were associated with delayed ischemic neurological deficit, but tachycardia and ST changes were associated with worse clinical outcome. Conclusions-QT prolongation and tachycardia on ECG were independently associated with angiographic vasospasm after aneurysmal SAH on multivariate analysis. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique Identifier: NCT00111085.

Electrocardiographic changes following intracranial haemorrhage: a retrospective cohort study

“…QTc prolongation is associated with IPH and vasospasm in SAH, 31,32 while AV block is considered an arrhythmia that is potentially fatal. 13 Interestingly, we observed that QTc prolongation and AV blocks were associated with neurological disease across all ICH types.…”

Neurological Soft Signs in Individuals with Pathological Gambling

“…Subjects with PG have greater amygdala activation in response to the alpha-2 adrenergic antagonist, yohimbine [60]. Research in laboratory animals [101] and humans [102], [103] has shown that increased sympathetic activity may cause vasospasm and microthrombosis resulting in diminished cerebral perfusion. It would be of interest to test whether antiadrenergic agents (e.g., clonidine or prazosin) might moderate the NSSs observed here.…”

Patient Phenotypes Associated With Outcomes After Aneurysmal Subarachnoid Hemorrhage

“…The most significantly associated component comprised the same patient phenotype associated with poor neurological outcome. Many of the same features including hemodynamic status, 17 WFNS grade, 14 and radiography injury 14 have been correlated previously with vasospasm. It is noteworthy that neutrophils are also increasingly understood to mediate early microvascular injury after SAH, 18 and immunomodulation of these cells' activity has been suggested as a strategy to prevent angiographic vasospasm.…”