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Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial.

Abstract：

BACKGROUND AND PURPOSE:Electrocardiographic abnormalities are common after subarachnoid hemorrhage, but their significance remains uncertain. The aim of this study was to determine whether any specific electrocardiographic abnormalities are independently associated with adverse neurological outcomes. METHODS:This was a substudy of the Intraoperative Hypothermia Aneurysm Surgery Trial, which was designed to determine whether intraoperative hypothermia would improve neurological outcome in patients with subarachnoid hemorrhage undergoing aneurysm surgery. The outcome was the 3-month Glasgow Outcome Score treated as both a categorical measure (Glasgow Outcome Score 1 [good outcome] to 5 [death]) and dichotomously (mortality/Glasgow Outcome Score 5 versus Glasgow Outcome Score 1 to 4). The predictor variables were preoperative electrocardiographic characteristics, including heart rate, corrected QT interval, and ST- and T-wave abnormalities. Univariate logistic regression was performed to screen for significant electrocardiographic variables, which were then tested for associations with the outcome by multivariate logistic regression adjusting for clinical covariates. RESULTS:The study included 588 patients, of whom 31 (5%) died. There was a significant, nonlinear association between heart rate and mortality such that lowest quartile (80 beats/min; OR, 8.8; P=0.006) were associated with higher risk. There was also a significant association between nonspecific ST- and T-wave abnormalities and mortality (OR, 3.1; P=0.031). CONCLUSIONS:Bradycardia, relative tachycardia, and nonspecific ST- and T-wave abnormalities are strongly and independently associated with 3-month mortality after subarachnoid hemorrhage. Further research should be performed to determine whether there is a causal relationship between cardiac dysfunction and neurological outcome after subarachnoid hemorrhage.

journal_name

Stroke

journal_title

Stroke

authors

Coghlan LA,Hindman BJ,Bayman EO,Banki NM,Gelb AW,Todd MM,Zaroff JG,IHAST Investigators.

doi

10.1161/STROKEAHA.108.528778

subject

Has Abstract

pub_date

2009-02-01 00:00:00

pages

412-8

issue

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.108.528778

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial.