Independent Predictors of One-Month Mortality in Patients with Intracranial Hemorrhage; a Cohort study

2021 ◽  
Author(s):  
Hamid Kariman ◽  
Behnam Babadi ◽  
Masomeh Raofi ◽  
Saeed Safari
Keyword(s):  
Cohort Study ◽  
Basal Ganglia ◽  
Blood Sugar ◽  
Intracranial Hemorrhage ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Wave Inversion ◽  
St Segment ◽  
One Year ◽  
Ecg Abnormalities

Introduction: Predicting the outcome is one of the most frequent and important issues when approaching patients with intracranial hemorrhage (ICH). Objective: This study aimed to evaluate the correlation of SUSPEKT score variables plus electrocardiogram (ECG) abnormalities with one-month mortality of patients with ICH presenting to emergency department (ED). Methods: In this cohort study, adult patients presenting to the EDs of three educational hospitals, during one year, were followed and their one-month mortality rate as well as independent predictors of outcome among the variables of SUSPEKT score plus electrocardiography findings were evaluated. Results: One hundred seventy-seven patients with the mean age of 63.07±14.89 years were studied (59.9%). The most common locations of intra-parenchymal hemorrhage were basal ganglia (53.7%) and cortex (36.2%). Ninety-two (52.0%) of cases had at least one ECG abnormality. The most frequent ECG abnormalities were ST segment depression (20.3%), T wave inversion (16.4%), and left ventricular hypertrophy (14.7%). Thirty (16.9%) cases died during the 30-day follow-up. Survived and non-survived cases were significantly different regarding the location of intra-parenchymal hemorrhage (p < 0.0001), presence of intraventricular hemorrhage (IVH) (p = 0.007), ST segment elevation (p < 0.0001), bradycardia (p < 0.0001), tachycardia (p < 0.0001), arterial fibrillation (p < 0.0001), blood sugar (p = 0.044), and serum level of potassium (p = 0.022). Conclusions: The location of hemorrhage (basal ganglia), higher blood sugar, and presence of ECG abnormalities (ST segment elevation, tachycardia, bradycardia, atrial fibrillation) were among the independent predictors of one-month mortality of ICH patients in this study.

Abstract 4840: Tako-Tsubo Cardiomyopathy without Apical Ballooning - Results of the German Tako-Tsubo Registry

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Anastasios Athanasiadis ◽  
Birke Schneider ◽  
Johannes Schwab ◽  
Uta Gottwald ◽  
Ellen Hoffmann ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ejection Fraction ◽  
Wall Motion ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment ◽  
Tako Tsubo Cardiomyopathy

Background : The German tako-tsubo cardiomyopathy (TTC) registry has been initiated to further evaluate this syndrome in a western population. We aimed to assess different patterns of left ventricular involvement in TTC. Methods : Inclusion criteria were: 1) acute chest symptoms, 2) reversible ECG changes (ST-segment elevation±T-wave inversion), 3) reversible left ventricular dysfunction with a wall motion abnormality not corresponding to a single coronary artery territory, 4) no significant coronary artery stenoses. Results : A total of 258 patients (pts) from 33 centers were included with a mean age of 68±12 years. Left ventriculography revealed the typical pattern of apical ballooning in 170 pts (66%) and an atypical mid-ventricular ballooning with normal wall motion of the apical and basal segments in 88 pts (34%). Mean age (68±11 vs 67±13 years) and gender distribution (150 women/20 men vs 80 women/8 men) were similar in both groups. Triggering events were present in 78% of the pts with apical ballooning (35% emotional, 34 physical and 9% combination) and in 75% of the pts with mid-ventricular ballooning (39% emotional, 25% physical and 11% combination). As assessed by left ventriculography, ejection fraction was significantly lower in pts with mid-ventricular ballooning (50±15% vs 45±13%, p=0.006). There was no difference in right ventricular involvement. Creatine kinase and troponin I were comparable in both groups. The ECG on admission showed ST-segment elevation in 87% of pts with apical ballooning and in 78% of pts with mid-ventricular ballooning. T-wave inversion was seen in 70% of the pts irrespective of the TTC variant. A Q-wave was significantly less present in pts with mid-ventricular ballooning (30% vs 16%, p=0.04). The QTc interval during the first 3 days was not different among both groups. Conclusion : A variant form with mid-ventricular ballooning was observed in one third of the pts with TTC. Left ventricular ejection fraction was significantly lower in these pts, although they revealed significantly less Q-waves on the admission ECG. All other parameters were similar and confirm the concept that apical and mid-ventricular ballooning represent two different manifestations of the same syndrome.

ECG features and arrhythmias in takotsubo syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 1298-1301
Author(s):  
Federico Migliore ◽  
Sebastiano Gili ◽  
Domenico Corrado
Keyword(s):  
Left Ventricular ◽  
Stunned Myocardium ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
T Wave ◽  
Wave Inversion ◽  
Qt Interval Prolongation ◽  
St Segment ◽  
Reversible Left Ventricular Dysfunction ◽  
Repolarization Abnormalities

Takotsubo syndrome (TTS) is typically characterized by dynamic electrocardiographic (ECG) repolarization changes, which consist of mild ST-segment elevation on presentation (acute phase) followed by T-wave inversion with QT interval prolongation within 24–48 h after presentation (subacute phase). It is noteworthy that subacute ECG repolarization abnormalities of TTS resemble those of the so-called Wellens’ ECG pattern, which is characterized by transient T-wave inversion in the anterior precordial leads as a result of either myocardial ischaemia or other non-ischaemic conditions, all characterized by a reversible left ventricular dysfunction (‘stunned myocardium’).

scholarly journals A STUDY OF ELECTROCARDIOGRAPHIC FINDINGS IN PATIENTS WITH ACUTE CVA

2020 ◽  
pp. 11-13
Author(s):  
Prasad Ugaragol ◽  
Edwin Jose
Keyword(s):  
Cerebral Infarction ◽  
Cerebral Hemorrhage ◽  
P Wave ◽  
Electrolyte Imbalance ◽  
St Segment Elevation ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment ◽  
Electrocardiographic Findings ◽  
Ecg Abnormalities

Background - Electrocardiographic abnormalities are common in patients with acute CVA, the possible mechanism of which is the disturbances in autonomic regulation and excessive stimulation of sympathetic nervous system resulting in disordered repolarization process. Physicians are often confronted due to ECG abnormalities in acute CVA since it often mimick that of myocardial ischemia. The present study was undertaken with the objective to describe the frequency and pattern of common ECG abnormalities in CVA. Methodology - This is a retrospective case series study conducted among patients with acute stroke admitted to HSK hospital bagalkot during February 2020 - August 2020. A 12 lead ECG of cases fulfilling the inclusion and exclusion criteria of our study were evaluated for characters like P wave,PR segment, QRS,ST segment, Q wave etc. Sample size estimation was done using open epi Software version 2.3.1 Results - Among the 90 cases, 70% had abnormal ECG. Among cerebral infarction 61(67.7%) cases, ST segment depression was found in 21(34.4%), Qtc prolongation in 16(26.2%), T wave inversion in 13(21.3%) and wide QRS in 14(22.9%). Among cerebral hemorrhage 24(26.6%), prolonged QTc was found in 10(41.6%), T wave inversion in 9(37.5%), ST segment elevation in 6(25%) and tall T wave in 4(16.6%) patients. In SAH patients, ST segment elevation was found in 2(40%), tall T wave in 2(40%), and T wave inversion in 2(40%). Conclusion - Abnormal electrocardiographic findings are common in patients with acute cerebrovascular accidents even in the absence of electrolyte imbalance or known organic heart disease. ECG abnormalities like ST segment elevation, tall T wave, T wave inversion, and prolonged QTc were commoner in cerebral infarction than in cerebral hemorrahge whereas ST segment depression was predominantly found in patients with cerebral hemorrhage. Understanding that these abnormalities are associated with acute CVA is important to avoid erroneous judgment of assigning these patients as having cardiac dysfunction.

scholarly journals Electrocardiographic Findings in Takotsubo Cardiomyopathy: ECG Evolution and Its Difference from the ECG of Acute Coronary Syndrome

2014 ◽  
Vol 8 ◽  
pp. CMC.S14086 ◽  
Author(s):  
June Namgung
Keyword(s):  
Acute Coronary Syndrome ◽  
Takotsubo Cardiomyopathy ◽  
Apical Ballooning ◽  
Left Ventricular ◽  
Qtc Interval ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Wave Inversion ◽  
St Segment

Background Electrocardiogram (ECG) manifestations of takotsubo cardiomyopathy (TC) produce ST-segment elevation or T-wave inversion, mimicking acute coronary syndrome (ACS). We describe the ECG manifestation of TC, including ECG evolution, and its different points from ACS. Methods We studied 37 consecutive patients (age 67 ± 15 years, range 23-89, M:F = 12:25) from March 2004 to November 2012 with a diagnosis of TC who were proven to have apical ballooning on echocardiography or left ventricular angiography and normal coronary artery. We analyzed their standard 12-lead ECGs, including rate, PR interval, QRS duration, corrected QT (QTc) interval, ECG evolutions, and arrhythmia events. Results Two common ECG findings in TC were ST-segment elevation (n = 13, 35%) and T inversion (n = 24, 65%), mostly in the precordial leads. After ST-segment resolution, in a few days (3.5 days), diffuse and often deep T-wave inversion developed. Eight patients (22%) had transient Q-waves lasting a few days in precordial leads. No reciprocal ST-segment depression was noted. T-wave inversion continued for several months. QT prolongation (>440 milliseconds) was observed in 37 patients (97%). There were no significant life-threatening arrhythmias except atrial fibrillation (n = 6, 16%). Conclusion There are distinct differences between the ECGs of TC and ACS. These differences will help to differentiate TC from ACS.

scholarly journals Brugada-Like Electrocardiographic Patterns Induced by Hyperkalemia

Medicina ◽  
2013 ◽  
Vol 49 (3) ◽  
pp. 24 ◽  
Author(s):  
Dagmara Reingardienė ◽  
Jolita Vilčinskaitė ◽  
Diana Bilskienė
Keyword(s):  
Brugada Syndrome ◽  
Structural Heart Disease ◽  
Electrolyte Disorders ◽  
St Segment Elevation ◽  
Wave Inversion ◽  
St Segment ◽  
Acute Renal Insufficiency ◽  
Channel Mutation ◽  
The Right ◽  
Ecg Abnormalities

Brugada syndrome was described in 1992 as a new clinical and electrocardiographic syndrome involving susceptibility to ventricular arrhythmias and sudden cardiac death in patients with no obvious structural heart disease. Brugada syndrome is characterized by a hereditary anomaly in the sodium ion channel (mutation of the SCN5A gene) identified by a wide QRS associated with the ST-segment elevation and the T‑wave inversion in the right precordial leads. The Brugada-like electrocardiographic pattern can be caused by sodium channel-blocking drugs and electrolyte disorders. Hyperkalemia may produce multiple ECG abnormalities, including the ST-segment elevation and pseudomyocardial infarction with a resolution of these abnormalities after the correction of hyperkalemia. This article describes 8 cases of pseudoanteroseptal myocardial infarction in acute renal insufficiency with hyperkalemia. The ST-segment elevation related to hyperkalemia is resolved by the reduced serum potassium level. Clinicians should recognize that hyperkalemia is one of the etiologies of the Brugada-like electrocardiographic pattern.

P1559Frailty is an independent predictor of one-year mortality in patients with ST-segment elevation myocardial infarction, regardless of age, clinical severity and left ventricular function

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Arroyo Espliguero ◽  
A Silva-Obregon ◽  
M C Viana-Llamas ◽  
A Estrella-Alonso ◽  
S Saboya-Sanchez ◽  
...  
Keyword(s):  
Cox Regression ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Clinical Severity ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Kaplan Meier ◽  
Vulnerable Patients ◽  
St Segment ◽  
One Year

Abstract Background Frailty is characterized by decline in physiologic reserve and function leading to increased vulnerability. Sarcopenia, one of its features, has been associated with cardiac dysfunction. Purpose Assess frailty-based mortality in ST-segment elevation myocardial infarction (STEMI) patients following primary angioplasty. Methods Retrospective cohort of 427 consecutive STEMI patients (64 years [55–75]; 78% men) admitted to a general ICU between November-2013 and February-2017. We assessed frailty with the Clinical Frailty Scale (CFS). We used Kaplan-Meier and Cox regression models for survival analysis, stratified by CFS score categories (Figure). For clinical relevance, patients were dichotomized in robust (CFS 1–3) and vulnerable (CFS ≥4). Results Vulnerable patients were older, had more comorbidities and a higher GRACE 2.0. They had lower CK and albumin levels and higher BNP levels, despite the lack of frailty-based differences in LVEF and MI size and location. One-year mortality rate was higher in vulnerable patients (Table). After Cox regression analysis, vulnerable patients (CFS ≥4) showed a 3.37-fold higher risk of one-year mortality than robust ones (95% CI, 1.59–7.15; P=0.002), independently of age, gender, GRACE 2.0 or LVEF. Baseline characteristics Vulnerable (CFS ≥4) Robust (CFS 1–3) P value (n=60) (n=367) One-year mortality, n (%) 15 (25) 14 (4.1) <0.001 Age (years) 78 [67–85] 61 [54–72] <0.001 Gender (women), n (%) 28 (46.7) 65 (17.7) <0.001 Hypertension, n (%) 47 (78.3) 156 (42.5) <0.001 Diabetes mellitus, n (%) 31 (51.7) 79 (21.5) <0.001 GRACE 2.0 150 [129–170.8] 112 [93–136] <0.001 Left ventricular ejection fraction (%) 52 [40–60] 55 [45–60] 0.151 MI location (anterior), n (%) 26 (43.3) 168 (45.8) 0.781 Creatin-phosphokinase (UI/L) 921 [286.8–2072] 1496 [607–2786] 0.011 High-sensitivity troponin I (pg/mL) 3699.5 [38–47968.1] 8789.8 [65.8–61970] 0.537 B-natriuretic peptide (pg/mL) 267.9 [117.3–901.6] 104.3 [29.5–268.7] <0.001 Albumin (g/L) 34.9 [32.8–37.4] 38.4 [35.7–40.4] <0.001 Kaplan-Meier and Cox survival curves. Conclusions Frailty is an independent predictor of one-year mortality in STEMI patients, independently of age, clinical severity and ventricular function. Frailty assessment should be routinely included in the clinical examination and decision-making process of STEMI patients.

scholarly journals Takotsubo Cardiomyopathy: An Unusual Case Report in a Patient Affected with Alzheimer’s Disease

2019 ◽  
pp. 1-3
Author(s):  
Pietro Gareri
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Case Report ◽  
Left Ventricular ◽  
Female Ratio ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Male Female Ratio ◽  
One Year

We describe a case report regarding an elderly woman affected with Alzheimer’s disease (AD), presenting to the ER for chest pain, and showing ST-segment elevation on electrocardiography, and elevated cardiac enzyme levels. She was hospitalized and after a number of laboratory and instrumental exams she was diagnosed Tako-tsubo syndrome. One year after the event she is feeling fine, electrocardiogram is normal, and no symptoms of cardiac heart failure are present. Tako-tsubo syndrome is a stress-induced cardiomyopathy that involves left ventricular apical akinesis and mimics acute coronary syndrome. It was first described in Japan in 1991, it is rare (1:36.000) with 1:3 male/female ratio and survival is usually 96%. The novelty of this case-report is due to its rarity and to the onset of the disease in an elderly patient affected with AD.

scholarly journals Cardiac Rupture—The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review

2021 ◽  
Vol 10 (5) ◽  
pp. 1066
Author(s):  
Małgorzata Zalewska-Adamiec ◽  
Hanna Bachórzewska-Gajewska ◽  
Sławomir Dobrzycki
Keyword(s):  
Female Gender ◽  
Left Ventricular ◽  
Cardiac Rupture ◽  
Control Group ◽  
Mechanical Complication ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
Risk Of Death ◽  
St Segment

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Arroyo-Espliguero ◽  
M.C Viana-Llamas ◽  
A Silva-Obregon ◽  
A Estrella-Alonso ◽  
C Marian-Crespo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Primary Angioplasty ◽  
Prognostic Impact ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Kaplan Meier ◽  
St Segment ◽  
One Year ◽  
The Impact

Abstract Background Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men. Purpose Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA). Methods Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI&lt;97.5, respectively. We used Kaplan-Meier survival model. Results Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P&lt;0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P&lt;0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P&lt;0.001) Conclusion Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

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