Time Course and Risk Factors for Myocardial Dysfunction After Aneurysmal Subarachnoid Hemorrhage
Time Course and Risk Factors for Myocardial Dysfunction After Aneurysmal Subarachnoid Hemorrhage
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DOI：
10.1227/neu.0000000000000699
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发表时间：
2015-06-01
期刊：
影响因子：
4.8
通讯作者：
Wilde, Arthur A.
中科院分区：
文献类型：
--
作者：
van der Bilt, Ivo A.;Hasan, Djo;Wilde, Arthur A.
背景：心肌壁运动异常（WMA）是动脉瘤性蛛网膜下腔出血（aSAH）患者预后不良的独立危险因素。 目的：研究 aSAH 后初始阶段 WMA 的时程，并探讨哪些临床、心电图或心肌血清标志物是 WMA 早期或晚期发展的预测因素。 方法：在一项针对 aSAH 患者的前瞻性、多中心队列研究中，我们进行了系列研究心电图和超声心动图并测量肌钙蛋白T和N末端B型利尿钠肽原。入院时出现的 WMA 被视为早期 WMA；那些在临床过程中发生的被认为是晚期 WMA。使用多变量回归分析，我们计算了早期或晚期发生 WMA 的临床参数、心电图和心肌血清标志物的比值比以及相应的 95% 置信区间。 结果：我们纳入了 301 名患者（平均年龄 +/- SD，57 +/- 13）岁。早期 WMA 的多变量比值比临床状况较差，为 2.7（95% 置信区间：1.1-6.8）；窦性心动过速，5.0（1.3-19.9）； ST 段压低，3.7 (1.02-13.1)； ST 段抬高，16.6 (1.5-178.9)；肌钙蛋白 T 增加，2.8 (1.1-7.3)。对于入院心电图显示的心肌梗塞模式，晚期发生 WMA 的多变量比值比（95% 置信区间）为 6.8 (1.6-30)，对于入院时肌钙蛋白 T 升高的情况为 3.4 (1.4-8.5)。 结论：WMA 可能在入院时出现或在 aSAH 病程中发生。入院时神经系统状况不佳、窦性心动过速、入院心电图 ST 段压低、ST 段抬高以及肌钙蛋白 T 升高是早期 WMA 的独立预测因素；入院心电图显示的心肌梗死模式和肌钙蛋白 T 升高独立预测晚期 WMA。
BACKGROUND: Myocardial wall motion abnormalities (WMAs) are independent risk factors for a poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH).OBJECTIVE: To study the time course of WMAs during the initial phase after aSAH and to investigate which clinical, electrocardiographic, or myocardial serum markers are predictors of early or late development of WMAs.METHODS: In a prospective, multicenter cohort study in patients with aSAH, we performed serial electrocardiography and echocardiography and measured troponin T and N-terminal pro-B-type natriuretic peptide. WMAs present on admission were considered early WMAs; those that developed during the clinical course were considered late WMAs. Using multivariable regression analysis, we calculated odds ratios with corresponding 95% confidence intervals for clinical parameters, electrocardiography, and myocardial serum makers with early or late occurrence of WMAs.RESULTS: We included 301 patients (mean age +/- SD, 57 +/- 13) years. Multivariable odds ratios for early WMAs were poor clinical condition, 2.7 (95% confidence interval: 1.1-6.8); sinus tachycardia, 5.0 (1.3-19.9); ST-segment depression, 3.7 (1.02-13.1); ST-segment elevation, 16.6 (1.5-178.9); and increased troponin T, 2.8 (1.1-7.3). Multivariable odds ratios (95% confidence intervals) for late development of WMAs were 6.8 (1.6-30) for a myocardial infarct pattern on admission electrocardiography and 3.4 (1.4-8.5) for increased troponin T on admission.CONCLUSION: WMAs may be present on admission or develop during the course of aSAH. Poor neurological condition on admission, sinus tachycardia, ST-segment depression, and ST-segment elevation on admission electrocardiography and increased troponin T are independent predictors of early WMAs; a myocardial infarct pattern on admission ECG and increased troponin T independently predict late WMAs.