title: ECG abnormalities predict neurogenic pulmonary edema in patients with subarachnoid hemorrhage.
abstract: OBJECTIVE
  The study aims to assess if electrocardiographic (ECG) abnormalities could predict the development of neurogenic pulmonary edema (NPE) within 24 hours in cases of spontaneous subarachnoid hemorrhage (SAH).
  
  
  METHODS
  We studied prospectively a cohort of 269 adult patients with nontraumatic SAH in an emergency department of a university-affiliated medical center. A 12-lead ECG was taken for these patients. The patients were stratified into NPE and non-NPE based on serially clinical and radiologic findings. The ECG abnormalities were compared between these 2 groups of patients.
  
  
  RESULTS
  Compared with the non-NPE (n = 229), the NPE (n = 40) had significantly higher World Federation of Neurological Surgeons class (P < .001), higher Hunt-Hess scale (P < .001), and higher prevalence of diabetes mellitus (P = .033). In addition, the percentage of ECG morphological abnormality was significantly higher in NPE, in which nonspecific ST- or T-wave changes (NSSTTCs) are significantly higher. Multiple logistic regression model identified World Federation of Neurological Surgeons class (95% confidence interval [CI], 2.6-13.3; P < .001), abnormal Q or QS wave (95% CI, 1.1-9.1; P = .038), and NSSTTCs (95% CI, 1.2-7.5; P = .016) as the significant variables associated with NPE.
  
  
  CONCLUSIONS
  Electrocardiographic abnormalities, especially abnormal Q or QS wave and NSSTTCs, may predict the development of NPE within 24 hours in adult patients with spontaneous SAH.
authors.affiliation: Department of Emergency Medicine, Cathay General Hospital, Taipei 106, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan. Electronic address: weilung.chen@msa.hinet.net.
authors.forename: Wei-Lung
authors.initials: WL
authors.lastname: Chen
authors.affiliation: School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan; Department of Cardiology, Cathay General Hospital, Taipei 106, Taiwan.
authors.forename: Chi-Hung
authors.initials: CH
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, Cathay General Hospital, Taipei 106, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan.
authors.forename: Jiann-Hwa
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Cathay General Hospital, Taipei 106, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan.
authors.forename: Henry Chih-Hung
authors.initials: HC
authors.lastname: Tai
authors.affiliation: Department of Emergency Medicine, Cathay General Hospital, Taipei 106, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan.
authors.forename: Su-Hen
authors.initials: SH
authors.lastname: Chang
authors.affiliation: Department of Radiology, Cathay General Hospital, Taipei 106, Taiwan; School of Medicine, Taipei Medical University, Taipei 106, Taiwan.
authors.forename: Yung-Cheng
authors.initials: YC
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology*; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology*; D013997:Time Factors