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Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model
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ECG abnormalities in predicting secondary cerebral ischemia after subarachnoid haemorrhage

W J Schuiling1, A Algra, A W de Weerd

  • 1Department of Neurology, Medical Center Leeuwarden, The Netherlands. wjschuiling@planet.nl

Acta Neurochirurgica
|June 23, 2006
PubMed

Insights

Electrocardiogram (ECG) abnormalities after subarachnoid hemorrhage (SAH) do not predict delayed cerebral ischemia (DCI). While some ECG changes indicate poor outcomes, they offer limited additional prognostic value beyond established scores.

Area of Science:

  • Neurology
  • Cardiology
  • Critical Care Medicine

Background:

  • Electrocardiogram (ECG) abnormalities are common after subarachnoid hemorrhage (SAH) and associated with poor outcomes.
  • The underlying mechanisms linking ECG changes to SAH outcomes remain unclear.
  • Cardiac dysfunction is hypothesized to contribute to delayed cerebral ischemia (DCI) post-SAH.

Purpose of the Study:

  • To investigate if electrocardiographic repolarization abnormalities on admission predict DCI after aneurysmal SAH.
  • To assess the additional prognostic value of ECG characteristics for clinical outcomes (WFNS, age, Hijdra score).

Main Methods:

  • 121 consecutive patients with aneurysmal SAH were analyzed.
  • Cox proportional hazard and logistic regression models were used to correlate ECG changes (ST/T-wave, QTc, U-wave) with DCI and poor outcome.
  • Receiver Operating Characteristic (ROC) curves evaluated the incremental prognostic value of ECG findings.

Main Results:

  • ST segment depression was significantly related to DCI in univariate analysis (HR 2.4).
  • ST-elevation, ST-depression, T-wave inversion, and ischemic ECG abnormalities were significantly related to poor outcome (ORs ranging from 2.5 to 10.6).
  • The area under the ROC curve (AUC) for predicting outcome improved from 0.81 to 0.84 with the addition of ECG characteristics.

Conclusions:

  • Electrocardiogram abnormalities do not predict DCI in SAH patients.
  • ECG findings have limited additional value in prognosticating poor outcomes beyond established clinical predictors.
  • DCI does not explain the relationship between ECG characteristics and clinical outcomes in SAH.
Abstract

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