Prognostic implications of left ventricular wall motion abnormalities associated with subarachnoid hemorrhage

Abstract

Left ventricular (LV) dysfunction generally occurs early in the course of subarachnoid hemorrhage (SAH). We evaluated the prognostic value of electrocardiographic (ECG) abnormalities and echocardiographic LV dysfunction evaluated shortly after SAH. We prospectively enrolled 47 SAH patients (62 ± 14 years, mean ± SD) who were admitted to the neurosurgical care unit of our institute. Neurological status was rated on the day of admission. Twelve-lead ECG and 2-dimensional echocardiography were recorded 2 ± 1 day after onset of SAH. ECG abnormalities (pathological Q-wave, ST-segment deviation, T-wave inversion, and QT prolongation) were evaluated and the incidences of global (LV ejection fraction < 50%) and segmental (regional wall motion abnormality [RWMA]) LV dysfunction were measured. During a follow-up period of 44 ± 23 days, 17 (36%) patients died. ECG abnormalities, LV ejection fraction < 50%, and RWMA were observed in 62%, 11%, and 28% of patients, respectively. Univariate Cox proportional hazards regression analysis revealed that neurological status, rate-corrected QT interval, LV ejection fraction, and RWMA were significant predictors of death. After adjustment for these significant clinical variables, and age. and sex, independent predictors of mortality were neurological status and RWMA. RWMA may provide significant prognostic information in patients with SAH.