Cardiac injury in traumatic subarachnoid hemorrhagea: prospective study in 35 patients

ABSTRACT

Various electrocardiographic abnormalities have been noted since 1954 in patients with head trauma complicated by subarachnoid hemorrhage [SAH]. However, very few studies have interested to these ECG modifications in the case of post traumatic SAH [t-SAH]. To assess the incidence of ECG abnormalities during the first five days after admission and the predictive value of these cardiac complications on the mortality in t-SAH. This prospective study included 35 patients out of 125 with traumatic SAH diagnosed in the emergency unit in Rabta's hospital [2001-2009]. Patients with cardio vascular history, thoracic trauma, non neurological coma and vascular-related neurological coma were excluded. An electrocardiogram monitoring was performed. A brain CT scan was performed in admission, 48 h after and case of neurological aggravation. Serum cardiac troponin 1C levels were determined on hospital admission and then on the third and fifth days of hospitalization. The statistical analysis was based on the non-parametric variance test of Kruskal-Wallis to compare the means; on the chi 2 and Fisher tests to compare percentage, with a significant result at 0.05 percentile and on the Odds ratio non-parametric factors for death. Association between 2 quantitative variables have been analyzed by Pearson coefficient of correlation. Mean age of the 35 patients was 39 +/- 17 years. Sex ratio was 4 in favor of men. The prevalence of electrocardiographic changes was of 57% [20 patients] Serum Troponin I level showed a peak on the 3rd day then it decreased. The majority of electrical abnormalities occurred during the third after admission and are associated to a markedly increased Troponin I plasma level and to the highest rate of mortality. Statistical analysis showed a significant correlation between T wave changes and the increase of serum Tn 1C level [p= 0; 0002]. The relative risk of mortality was higher than 7.2 times in cases with increase serum Tnlc level. We demonstrated that ECG changes were common in patients with t SAH and the major predictive factors of mortality were the increase of serum TnIC and T wave changes Subarachnoid hemorrhage [SAH] is a complication of head trauma inducing frequently cerebral vasospasm and even cerebral infarct. Various electrocardiographic abnormalities have been noted in patients with head trauma complicated by subarachnoid hemorrhage [1-5]. They are considered to be secondary to the massive catecholamine discharge in systemic circulation [6, -9]. Serum cardiac troponin I [Tnl] was considered a highly sensitive and specific marker of myocardial cell lesion and might be regularly performed in these patients to detect early myocardial ischemia. We carried out a prospective study in 35 patients with traumatic SAH [tSAH] in order to assess the incidence of coronary complications during the first five days after admission and to demonstrate the interest of troponin le blood assay in the diagnosis of coronary abnormalities