Electrocardiographic changes predict angiographic vasospasm after aneurysmal subarachnoid hemorrhage

Area of Science:

• Cardiology
• Neurology
• Critical Care Medicine

Background:

• Aneurysmal subarachnoid hemorrhage (SAH) can lead to serious complications like angiographic vasospasm.
• Increased central sympathetic activity is implicated in both SAH-related ECG changes and vasospasm.
• Early identification of patients at risk for vasospasm is crucial for mitigating adverse outcomes.

Purpose of the Study:

• To investigate the association between electrocardiographic (ECG) changes and the occurrence of angiographic vasospasm following aneurysmal SAH.
• To determine if specific ECG findings can serve as early predictors of vasospasm in SAH patients.

Main Methods:

• Analysis of data from 413 patients in the prospective CONSCIOUS-1 trial.
• ECGs were recorded within 24 hours of rupture and during the vasospasm risk period.
• Angiographic vasospasm was assessed via catheter angiography; multivariate logistic regression identified significant associations.

Main Results:

• QT prolongation was the most frequent ECG finding (42% initially, 25% during risk period).
• Prolonged QT interval and tachycardia on baseline ECG were associated with angiographic vasospasm (OR 1.86, OR 10.83).
• QT prolongation during the risk period also correlated with vasospasm (OR 3.53); tachycardia and ST changes predicted worse outcomes.

Conclusions:

• QT prolongation and tachycardia on ECG are independently associated with angiographic vasospasm post-aneurysmal SAH.
• These ECG findings may aid in the early risk stratification of SAH patients for vasospasm.