Abnormal ECG With Subarachnoid Haemorrhage Linked to Poorer Outcomes

September 7, 2021
By Nancy Melville BRUSSELS -- September 7, 2021 -- Abnormal electrocardiogram (ECG) results in people with subarachnoid haemorrhage are associated with higher mortality rates and other poorer outcomes, according to a study presented at the 40th International Symposium on Intensive Care and Emergency Medicine. “Since more than 50% of echocardiograms in patients with subarachnoid haemorrhage [have] an abnormal ECG showing reduced left ventricular function, an abnormal ECG on admission in patients with subarachnoid haemorrhage should trigger an echocardiography to detect cardiac complications,” said Manu Rabaey, MD, Ghent University Hospital, Ghent, Belgium. For the study, the researchers evaluated the ECGs obtained on admission of 145 patients at the Ghent University Hospital with aneurysmal subarachnoid haemorrhage between January 2017 and December 2020. Of the patients, 74 had normal ECGs, while 71 had abnormal readings -- defined as either a significant ST-elevation or depression, a significant T-wave inversion, or an abnormal QTc (>440 ms for men, >460 ms for women). Patients with abnormal ECGs had significantly increased arterial hypertension compared with those with normal ECGs (30% vs 15%; P = .033), but no other significant differences between groups were observed, including age and active smoking. Approximately 60% were female in each group, and 13% in the abnormal ECG group had cardiovascular disease versus 5% in the normal ECG group, which was not a significant difference (P = .126). Of those with abnormalities on their ECG, 66% showed a prolonged QTc, 12% had ST-T changes, and 21% had both features. Echocardiograms were performed among 7 (9%) patients with a normal ECG and just among 18 (25%) of those with abnormal findings. Reduced left ventricular ejection fraction was observed on 10 echocardiograms -- all in the group with abnormal ECGs. Patients with normal ECGs had a significantly lower mean intensive care unit (ICU) stay versus those with abnormal ECGs (7.7 days vs 12.2 days, respectively; P = .003). Having a normal ECG was also associated with a lower rate of in-hospital mortality (6.7% vs 20.0%, respectively; P = .021). A reduced ejection fraction was not associated with higher mortality. “ECG changes in patients with subarachnoid haemorrhage are associated with longer ICU length of stay and higher hospital mortality,” said Dr. Rabaey. Despite the increased risks with abnormal ECG results, echocardiography was performed only in 25% of patients with ECG changes. Dr. Rabaey said that increasing the use of echocardiograms could have the benefit of improving patient outcomes after subarachnoid haemorrhage. [Presentation title: Association Between ECG Changes and Prognosis in Subarachnoid Hemorrhage. Abstract A81]