title: Cardiovascular Abnormalities and in-Hospital All-Cause Mortality in Patients with Spontaneous Sub-Arachnoid Hemorrhage: An Observational Study.
abstract: BACKGROUND
  Patients 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  A 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).
  
  
  CONCLUSIONS
  Prolonged 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.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, USA. ahmed.mahmoud@medicine.ufl.edu.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Mahmoud
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, USA.
authors.forename: Akram Y
authors.initials: AY
authors.lastname: Elgendy
authors.affiliation: Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, USA.
authors.forename: Hend
authors.initials: H
authors.lastname: Mansoor
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, USA.
authors.forename: Islam Y
authors.initials: IY
authors.lastname: Elgendy
keywords: Cardiac; Echocardiography; Mortality; Sub-arachnoid hemorrhage