Elevated cardiac troponin I (≥0.3 ng/mL) after aneurysmal subarachnoid hemorrhage was associated with early ejection fraction <50% (44% vs 5%, P<0.0001) and regional wall motion abnormalities.
Cohort (n=204)
Is elevated cardiac troponin I associated with persistent electrocardiographic and echocardiographic abnormalities in patients with aneurysmal subarachnoid hemorrhage?
Elevated cardiac troponin I after aneurysmal subarachnoid hemorrhage is associated with persistent QTc prolongation, ventricular arrhythmias, and left ventricular dysfunction.
Absolute Event Rate: 44% vs 5%
p-value: p=<0.0001
BACKGROUND AND PURPOSE: Cardiac injury persistence after aneurysmal subarachnoid hemorrhage (aSAH) is not well described. We hypothesized that post-aSAH cardiac injury, detected by elevated cardiac troponin I (cTnI), is related to aSAH severity and associated with electrocardiographic and structural echocardiographic abnormalities that are persistent. METHODS: Prospective longitudinal study was conducted of patients with aSAH with Fisher grade >or=2 and/or Hunt/Hess grade >or=3. Serum cTnI was collected on Days 1 to 5; cohort dichotomized into peak cTnI >or=0.3 ng/mL (elevated) or cTnI or=7 days), Holter monitoring on Days 1 to 5, and transthoracic echocardiogram (left ventricular ejection fraction and regional wall motion abnormalities) early (Days 0 to 5) and late (Days 5 to 12) were evaluated. RESULTS: Of 204 subjects, 31% had cTnI >or=0.3 ng/mL. cTnI >or=0.3 ng/mL was incrementally related to aSAH severity by admission symptoms (Hunt/Hess P=0.001) and blood load (Fisher P=0.028). More patients with cTnI >or=0.3 ng/mL had prolonged QTc on early (63% versus 30%, Por=0.3 ng/mL had ventricular tachycardia/fibrillation (22% versus 9%, P=0.018) but not atrial fibrillation/flutter (P=0.241). Cardiac troponin I >or=0.3 ng/mL was associated with both early ejection fraction <50% (44% versus 5%, P<0.0001) and regional wall motion abnormalities (44% versus 4%, P<0.0001). Regional wall motion abnormalities predominated in basal and midventricular segments and persisted to some degree in 73% of patients affected, whereas ejection fraction <50% persisted in 59% of patients affected. CONCLUSIONS: Cardiac injury is incrementally worse with increasing aSAH severity and associated with persistent QTc prolongation and ventricular arrhythmias. Regional wall motion abnormalities and depressed ejection fraction persist to some degree in the majority of those affected.
Hravnak et al. (Fri,) conducted a cohort in Aneurysmal subarachnoid hemorrhage (n=204). Elevated cardiac troponin I (≥0.3 ng/mL) vs. Cardiac troponin I <0.3 ng/mL was evaluated on Early ejection fraction <50% (p=<0.0001). Elevated cardiac troponin I (≥0.3 ng/mL) after aneurysmal subarachnoid hemorrhage was associated with early ejection fraction <50% (44% vs 5%, P<0.0001) and regional wall motion abnormalities.