title: Time course and risk factors for myocardial dysfunction after aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Myocardial wall motion abnormalities (WMAs) are independent risk factors for a poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).
  
  
  OBJECTIVE
  To study the time course of WMAs during the initial phase after aSAH and to investigate which clinical, electrocardiographic, or myocardial serum markers are predictors of early or late development of WMAs.
  
  
  METHODS
  In a prospective, multicenter cohort study in patients with aSAH, we performed serial electrocardiography and echocardiography and measured troponin T and N-terminal pro-B-type natriuretic peptide. WMAs present on admission were considered early WMAs; those that developed during the clinical course were considered late WMAs. Using multivariable regression analysis, we calculated odds ratios with corresponding 95% confidence intervals for clinical parameters, electrocardiography, and myocardial serum makers with early or late occurrence of WMAs.
  
  
  RESULTS
  We included 301 patients (mean age ± SD, 57 ± 13) years. Multivariable odds ratios for early WMAs were poor clinical condition, 2.7 (95% confidence interval: 1.1-6.8); sinus tachycardia, 5.0 (1.3-19.9); ST-segment depression, 3.7 (1.02-13.1); ST-segment elevation, 16.6 (1.5-178.9); and increased troponin T, 2.8 (1.1-7.3). Multivariable odds ratios (95% confidence intervals) for late development of WMAs were 6.8 (1.6-30) for a myocardial infarct pattern on admission electrocardiography and 3.4 (1.4-8.5) for increased troponin T on admission.
  
  
  CONCLUSIONS
  WMAs may be present on admission or develop during the course of aSAH. Poor neurological condition on admission, sinus tachycardia, ST-segment depression, and ST-segment elevation on admission electrocardiography and increased troponin T are independent predictors of early WMAs; a myocardial infarct pattern on admission ECG and increased troponin T independently predict late WMAs.
  
  
  BACKGROUND
  NCT00123695.
authors.affiliation: *Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam; ‡Department of Cardiology, University Medical Center, Utrecht; §Department of Intensive Care, Erasmus Medical Center, Rotterdam; ¶Department of Neurology, Erasmus Medical Center, Rotterdam; ‖Department of Intensive Care, University Medical Center, Groningen; #Department of Cardiology, University Medical Center, Groningen; **Department of Neurosurgery, University Medical Center, Groningen; ‡‡Department of Cardiology, Erasmus Medical Center, Rotterdam; §§Department of Cardiology, VU University Medical Center; ¶¶Department of Cardiology, Haga Teaching Hospital the Hague; ‖‖Department of Intensive Care, Academic Medical Center, Amsterdam; ##Department of Intensive Care, VU University Medical Center; ***Neurosurgical Center Amsterdam at Academic Medical Center and VU University Medical Center, Amsterdam; ‡‡‡Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht; §§§Departments of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, the Netherlands.
authors.forename: Ivo A
authors.initials: IA
authors.lastname: van der Bilt
authors.forename: Djo
authors.initials: D
authors.lastname: Hasan
authors.forename: Renee B
authors.initials: RB
authors.lastname: van den Brink
authors.forename: Maarten J
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: Joost G
authors.initials: JG
authors.lastname: Regtien
authors.forename: Maarten P
authors.initials: MP
authors.lastname: van den Berg
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Groen
authors.forename: Folkert J Ten
authors.initials: FJ
authors.lastname: Cate
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Götte
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.forename: Armand R
authors.initials: AR
authors.lastname: Girbes
authors.forename: W Peter
authors.initials: WP
authors.lastname: Vandertop
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Wilde
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D020127:Recovery of Function; D012044:Regression Analysis; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain