ECG abnormalities predict neurogenic pulmonary edema in patients with subarachnoid hemorrhage

• Published in: The American journal of emergency medicine Vol. 34; no. 1; pp. 79 - 82
• Main Authors: Chen, Wei-Lung, MD, MS, PhD, Huang, Chi-Hung, MD, Chen, Jiann-Hwa, MD, MPH, PhD, Tai, Henry Chih-Hung, MD, Chang, Su-Hen, MD, Wang, Yung-Cheng, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Adult; Aged; Electrocardiography; Emergency; Emergency Service, Hospital; Female; Heart Rate; Humans; Male; Middle Aged; Prospective Studies; Pulmonary Edema - etiology; Risk Factors; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - physiopathology; Time Factors
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2015.09.032

Abstract Objective The study aims to assess if electrocardiographic (ECG) abnormalities could predict the development of neurogenic pulmonary edema (NPE) within 24 hours in cases of spontaneous subarachnoid hemorrhage (SAH). Methods We studied prospectively a cohort of 269 adult patients with nontraumatic SAH in an emergency department of a university-affiliated medical center. A 12-lead ECG was taken for these patients. The patients were stratified into NPE and non-NPE based on serially clinical and radiologic findings. The ECG abnormalities were compared between these 2 groups of patients. Results Compared with the non-NPE (n = 229), the NPE (n = 40) had significantly higher World Federation of Neurological Surgeons class ( P < .001), higher Hunt-Hess scale ( P < .001), and higher prevalence of diabetes mellitus ( P = .033). In addition, the percentage of ECG morphological abnormality was significantly higher in NPE, in which nonspecific ST- or T-wave changes (NSSTTCs) are significantly higher. Multiple logistic regression model identified World Federation of Neurological Surgeons class (95% confidence interval [CI], 2.6-13.3; P < .001), abnormal Q or QS wave (95% CI, 1.1-9.1; P = .038), and NSSTTCs (95% CI, 1.2-7.5; P = .016) as the significant variables associated with NPE. Conclusions Electrocardiographic abnormalities, especially abnormal Q or QS wave and NSSTTCs, may predict the development of NPE within 24 hours in adult patients with spontaneous SAH.