QTc Interval and Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage

Ichinomiya, Taiga; Terao, Yoshiaki; Miura, Keiji; Higashijima, Ushio; Tanise, Tomomi; Fukusaki, Makoto; Sumikawa, Koji

doi:10.1007/s12028-010-9411-9

Cited by 25 publications

(13 citation statements)

References 37 publications

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“…The presence of prolonged QTc interval was associated with a five-times-increased risk of death in SAH patients, compared to those with normal QTc interval. This concurs with the previous studies that evaluated prolonged QTc interval prognostic significance [7, 8]. Ichinomiya et al reached a conclusion similar to ours; however, they used the Glasgow Outcome Scale at hospital discharge, as a primary outcome, rather than in-hospital mortality.…”

Section: Discussionsupporting

confidence: 91%

“…Ichinomiya et al reached a conclusion similar to ours; however, they used the Glasgow Outcome Scale at hospital discharge, as a primary outcome, rather than in-hospital mortality. They found that a QTc of 448 ms at day 7 of admission was 73% sensitive (95% CI 68–78%) and 93% specific (95% CI 90–96%) prognostic tool to detect such outcome [7]. Marafioti et al reported that prolonged QTc was an independent prognostic tool for detection of index mortality in SAH patients when it was compared to other prognostic risk factors such as clinical and CT grading of SAH.…”

Section: Discussionmentioning

confidence: 99%

“…In a meta-analysis of 25 studies, there was a positive association between various cardiovascular abnormalities and mortality in SAH [6]. A few studies illustrated an association and prognostic significance of prolonged QTc in relation to SAH morbidity and mortality [7, 8], while other studies demonstrated that elevated troponin level was associated with increased mortality [9, 10]. A recent study suggested that resting segmental wall motion abnormality (RSWMA) was the only prognostic indicator of short-term mortality, while other cardiovascular abnormalities including QTc prolongation, elevated troponins, or pro-brain natriuretic peptide (BNP), were not significant on multivariable regression analysis [11].…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Abnormalities and in-Hospital All-Cause Mortality in Patients with Spontaneous Sub-Arachnoid Hemorrhage: An Observational Study

2016

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IntroductionPatients with spontaneous sub-arachnoid hemorrhage (SAH) might develop various cardiac abnormalities, however; the prognostic implications of these cardiac abnormalities are not well known. This study aimed to detect the cardiac abnormality that correlates best with in-hospital all-cause mortality in patients with SAH.MethodsIn this retrospective study, all patients admitted to our institution with a primary diagnosis of SAH, and underwent a transthoracic echocardiogram (TTE) from July 2011 until May 2014, were enrolled. Data gathered included patients’ demographics, Hunt and Hess clinical grading, computed tomography SAH Fisher grading, troponin T level, electrocardiographic (ECG) changes, TTE, and in-hospital all-cause mortality. Multivariate logistic regression of the cardiac abnormalities and in-hospital all-cause mortality was performed.ResultsA total of 247 patients were included in our analysis. In-hospital all-cause mortality was 15.6% (38 patients). The presence of elevated troponin T levels, resting segmental wall motion abnormalities, reduced ejection fraction (<35%), and prolonged corrected QT interval (QTc) on ECG were associated with increased in-hospital all-cause mortality on univariate analysis. On multivariable regression, QTc prolongation was the only independent predictor for in-hospital all-cause mortality (p = 0.04).ConclusionsProlonged QTc interval on ECG was independently associated with in-hospital all-cause mortality in patients presenting with spontaneous SAH. Whether this is a causative association or a marker of underlying severe clinical presentation of SAH remains unknown.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Abnormalities and in-Hospital All-Cause Mortality in Patients with Spontaneous Sub-Arachnoid Hemorrhage: An Observational Study

2016

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“…Nevertheless, these analyses suggested that only female sex and hypokalemia were an independent risk factor for severe QTc prolongation in SAH patients [66]. It has been confirmed that QTc interval prolongation improved in patients with a good prognosis; it persisted in SAH patients with a poor outcome, further indicating that a QTc interval of longer than 448 ms at 7 days after surgery can serve as a predictor of clinical outcome following SAH [67]. Twenty-three patients with SAH were examined, who showed an ST segment elevation in their ECG [68].…”

Section: Manifestations Of Nonneurologic Complications After Sahmentioning

confidence: 99%

The Harmful Effects of Subarachnoid Hemorrhage on Extracerebral Organs

Chen

et al. 2014

BioMed Research International

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Subarachnoid hemorrhage (SAH) is a devastating neurological disorder. Patients with aneurysmal SAH develop secondary complications that are important causes of morbidity and mortality. Aside from secondary neurological injuries, SAH has been associated with nonneurologic medical complications, such as neurocardiogenic injury, neurogenic pulmonary edema, hyperglycemia, and electrolyte imbalance, of which cardiac and pulmonary complications are most common. The related mechanisms include activation of the sympathetic nervous system, release of catecholamines and other hormones, and inflammatory responses. Extracerebral complications are directly related to the severity of SAH-induced brain injury and indicate the clinical outcome in patients. This review provides an overview of the extracerebral complications after SAH. We also aim to describe the manifestations, underlying mechanisms, and the effects of those extracerebral complications on outcome following SAH.

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“…21 The association in the current study between prolonged QT interval and angiographic vasospasm may explain the findings of Ichinomiya and colleagues who found that a prolonged QT interval (Ͼ448 ms) at 7 days postaneurysm rupture was a predictor of neurological outcome. 35 This group furthermore found that improvement in QT prolongation was associated with favorable outcome, suggesting a role for angiographic vasospasm as a mechanistic explanation. A significant limitation of previous studies is the lack of assessment of angiographic data to diagnose vasospasm.…”

Section: Discussionmentioning

confidence: 96%

Electrocardiographic Changes Predict Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Ibrahim

Macdonald

2012

Stroke

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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.

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QTc Interval and Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage

Cited by 25 publications

References 37 publications

Cardiovascular Abnormalities and in-Hospital All-Cause Mortality in Patients with Spontaneous Sub-Arachnoid Hemorrhage: An Observational Study

Cardiovascular Abnormalities and in-Hospital All-Cause Mortality in Patients with Spontaneous Sub-Arachnoid Hemorrhage: An Observational Study

The Harmful Effects of Subarachnoid Hemorrhage on Extracerebral Organs

Electrocardiographic Changes Predict Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage

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