Abstract 9349: Asymptomatic Left Ventricular Apical Ballooning as a Potential Risk Factor in Patients with Nontraumatic Subarachnoid Hemorrage

Abstract

Background: The degree of consciousness impairment at onset in patients(pts) with non-traumatic subarachnoid hemorrhage (NSH) has been found to be closely related to prognosis. Pts with NSH sometimes present with ECG abnormalities or asymptomatic left ventricular apical ballooning (A-LVAB), however risk stratification in pts with NSH still remains unknown. We investigated whether ECG abnormalities and A-LVAB could provide additional risk stratification in patients with NSH.

Methods: We studied 73 pts (51 females, mean age 69±15 yrs) without a history of heart disease. Neurological grade (Hunt and Kosnik grade) and clinical factors were evaluated. The standard 12-lead ECG and echocardiography were performed within 48 hours after the onset of NSH. ECG abnormalities were defined as abnormal Q wave, ST elevation, ST depression, T-wave inversion, giant T-wave inversion or QT prolongation. We assessed A-LVAB using echocardiography.

Results: Intervention therapy (clipping 52pts, embolization 11pts) was performed in 63 of 73 patients and 8 of 73 patients (11%) died in the first month after the onset of NSH. A-LVAB was present in 6pts (8%). Death was significantly associated with intervention therapy (p=0.0002), neurological grade (p=0.0003) and A-LVA (p<0.0001), while ECG abnormalities were not significantly associated. Neurological grade (p=0.0326) and A-LVAB (p=0.0107, hazard ratio 39.134, 95%CI 2.341 to 654.185) were independently associated with death.

Conclusion: Asymptomatic left ventricular apical ballooning could provide additional risk stratification in the acute phase of patients with non-traumatic subarachnoid hemorrhage.