title: Cardiac dysfunction after aneurysmal subarachnoid hemorrhage: relationship with outcome.
abstract: OBJECTIVE
  To assess whether cardiac abnormalities after aneurysmal subarachnoid hemorrhage (aSAH) are associated with delayed cerebral ischemia (DCI) and clinical outcome, independent from known clinical risk factors for these outcomes.
  
  
  METHODS
  In a prospective, multicenter cohort study, we performed echocardiography and ECG and measured biochemical markers for myocardial damage in patients with aSAH. Outcomes were DCI, death, and poor clinical outcome (death or dependency for activities of daily living) at 3 months. With multivariable Poisson regression analysis, we calculated risk ratios (RRs) with corresponding 95% confidence intervals. We used survival analysis to assess cumulative percentage of death in patients with and without echocardiographic wall motion abnormalities (WMAs).
  
  
  RESULTS
  We included 301 patients with a mean age of 57 years; 70% were women. A wall motion score index ≥1.2 had an adjusted RR of 1.2 (0.9-1.6) for DCI, 1.9 (1.1-3.3) for death, and 1.8 (1.1-3.0) for poor outcome. Midventricular WMAs had adjusted RRs of 1.1 (0.8-1.4) for DCI, 2.3 (1.4-3.8) for death, and 2.2 (1.4-3.5) for poor outcome. For apical WMAs, adjusted RRs were 1.3 (1.1-1.7) for DCI, 1.5 (0.8-2.7) for death, and 1.4 (0.8-2.5) for poor outcome. Elevated troponin T levels, ST-segment changes, and low voltage on the admission ECGs had a univariable association with death but were not independent predictors for outcome.
  
  
  CONCLUSIONS
  WMAs are independent risk factors for clinical outcome after aSAH. This relation is partly explained by a higher risk of DCI. Further study should aim at treatment strategies for these aSAH-related cardiac abnormalities to improve clinical outcome.
authors.affiliation: From the Departments of Cardiology (I.v.d.B, D.H., R.v.d.B., A.W.) and Intensive Care (J.H.), Academic Medical Center Amsterdam; Department of Cardiology (M.-J.C.), University Medical Center Utrecht; Departments of Intensive Care (M.v.d.J.), Neurology (F.v.K.), and Cardiology (F.t.C.), Erasmus Medical Center Rotterdam; Departments of Intensive Care (J.M.), Cardiology (M.v.d.B.), and Neurosurgery (R.G.), University Medical Center Groningen; Departments of Cardiology (O.K.) and Intensive Care (J.G.), VU University Medical Center; Department of Cardiology (M.G.), Haga Hospital The Hague; Department of Neurosurgical Center Amsterdam (P.V.), Academic Medical Center and VU University Medical Center; Department of Clinical Epidemiology (A.A.), Julius Center for Health Sciences and Primary Care; Departments of Neurology and Neurosurgery (A.A., G.R.), Utrecht Stroke Center, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht; and Stichting CardioZorg (F.V.), Amsterdam, the Netherlands.
authors.forename: Ivo
authors.initials: I
authors.lastname: van der Bilt
authors.forename: Djo
authors.initials: D
authors.lastname: Hasan
authors.forename: Renee
authors.initials: R
authors.lastname: van den Brink
authors.forename: Maarten-Jan
authors.initials: MJ
authors.lastname: Cramer
authors.forename: Mathieu
authors.initials: M
authors.lastname: van der Jagt
authors.forename: Fop
authors.initials: F
authors.lastname: van Kooten
authors.forename: John
authors.initials: J
authors.lastname: Meertens
authors.forename: Maarten
authors.initials: M
authors.lastname: van den Berg
authors.forename: Rob
authors.initials: R
authors.lastname: Groen
authors.forename: Folkert
authors.initials: F
authors.lastname: Ten Cate
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.forename: Marco
authors.initials: M
authors.lastname: Götte
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.forename: Johan
authors.initials: J
authors.lastname: Groeneveld
authors.forename: Peter
authors.initials: P
authors.lastname: Vandertop
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Frans
authors.initials: F
authors.lastname: Visser
authors.forename: Arthur
authors.initials: A
authors.lastname: Wilde
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rinkel
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D009426:Netherlands; D016017:Odds Ratio; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D020097:Natriuretic Peptide, Brain