Study of the Clinical, Electrocardiographic and Biochemical Spectrum of Cardiovascular Complications in Patients With Aneurysmal Subarachnoid Hemorrhage − An Initial Experience at a Tertiary Centre in India

Abstract

Objectives: Aneurysmal subarachnoid hemorrhage (SAH) is an extremely fatal condition with mortality as high as 45%. Apart from the intra-cranial causes, there are cardiovascular events, which add to the morbidity and mortality. These can manifest with deranged cardiac biomarkers. However, quantitative assessment of these biochemical markers and its correlation with prognosis has not been adequately studied. We tried to analyse the spectrum and outcome of cardiovascular complications in patients with aneurysmal SAH and whether elevated levels of serum biochemical markers have any association with the prognosis. Study Design: Prospective observational study. Materials and Method: We included patients of all grades of aneurysmal SAH with ictus less than 48 hours at the time of admission. The patient’s serum biochemical marker levels [troponin T (TnT), total creatine phosphokinase (CPK), cardiac-specific creatine phosphokinase (CPK − MB), brain natriuretic peptide (BNP) and C reactive protein (CRP)] were measured for 6 consecutive days from the day of admission (Day 0). Patient also underwent 12 lead Electrocardiography (ECG) and two dimensional echocardiography (2D Echo) on Day 0, Day 1 and Day 5. Statistical Analysis: Data analysis was performed by using Statistical Package for Social Sciences (SPSS) version 20:0. Chi-square test and Fisher’s exact test were used to find the association between diagnosis and various data variables associated with diagnosis. P value less than 0.05 was considered as significant. Data was graphically depicted with the help of box plots. Receiver Operating Characteristic (ROC) curves were plotted for TnT, CPK and BNP. Results: Twenty five patients were enrolled in the study. Out of the five serum biochemical markers studied, TnT, CPK and BNP were statistically associated with outcome. Serum TnT levels on day 4; serum CPK levels on day 3 and day 4; and serum BNP levels on day 3, day 4 and day 5 were statistically significant. BNP was the serum biochemical marker which had the strongest statistical association with outcome. ECG abnormalities were observed in 76% of the cases. Prolonged corrected QT (QTc) interval was the most common abnormal ECG finding among the patients who died. One patient developed 3rd degree heart block and another patient developed left ventricular dysfunction with an ejection fraction of 40% on 2D Echo following aneurysmal SAH. Conclusion: Cardiovascular complications are common in patients with aneurysmal SAH. Serum quantitative levels of TnT, CPK and BNP can be incorporated in the battery of routine blood tests in SAH patients for predicting outcome.

Keywords

• aneurysmal subarachnoid hemorrhage
• biochemical markers
• brain natriuretic peptide
• cardiovascular complications
• total creatine phosphokinase
• troponin t