Subarachnoid Hemorrhage, Aneurysmal
Conditions
Keywords
Subarachnoid Hemorrhage, Aneurysmal, Non-traumatic, Electrocardiography, frontal-QRST angle, 28-day mortality
Brief summary
The investigators investigated the association between the frontal QRS/T angle measured on admission ECG and 28-day mortality, as well as neurological outcome in patients with non-traumatic aneurysmal SAH. Specifically, the investigators tested the hypothesis that an increased frontal QRS/T angle would be independently associated with higher mortality and poorer clinical outcomes in patients with SAH. Accordingly, the investigators also analyzed the relationship between the frontal QRS/T angle and neurological status assessed based on Glasgow Outcome Scale (GOS), as well as disease severity determined by the Hunt-Hess and Fisher grading systems.
Detailed description
Patients were divided into two groups: survivors and non-survivors. Survivors were further classified as mobile or immobile according to the Glasgow Outcome Scale (GOS). Patients who remained comatose or dependent in daily activities were classified as immobile (GOS 1-3), while those who returned to normal life or were able to perform daily activities independently were classified as mobile (GOS 4-5). Demographic and clinical characteristics as well as ECG findings were compared between these groups, and the relationship between the frontal QRS/T angle, 28-day mortality, and disease severity was evaluated. Independent predictors of mortality were determined by multivariate logistic regression analysis of variables (demographic characteristics, clinical characteristics, and ECG changes) that differed significantly between survivors and non-survivors. An area under the curve (AUC) analysis was then conducted to identify the predictive role of the f-QRST angle in patients with SAH.
Interventions
OTHERfrontal-QRST angle
The frontal QRS/T angle represents the angle between the ventricular depolarization (QRS) and repolarization (T) vectors on the ECG and serves as a parameter for assessing cardiac electrical heterogeneity. In this study, the frontal QRS/T angle was calculated using data obtained from standard 12-lead surface ECGs. The QRS and T axes in the frontal plane were derived from the automated ECG device reports.
OTHERHunt-Hess scale
The Hunt-Hess scale was used to assess SAH severity according to the clinical presentation and the visible neurological deficits. The Grades run from 1 to 5: - Grade 1: Asymptomatic or minimal headache, slight neck stiffness. - Grade 2: Moderate to severe headache, and neck stiffness, but no neurological deficit except cranial nerve palsy. - Grade 3: Drowsiness, confusion, or a mild focal deficit. - Grade 4: Stupor, moderate to severe hemiparesis, early decerebrate rigidity, and vegetative disturbance. - Grade 5: Deep coma, decerebrate rigidity, and a moribund appearance.
The modified Fisher scale was used to evaluate SAH severity by reference to the extent of hemorrhage as revealed by CT of the brain. Four grades are depending on the degree of bleeding observed: - Grade 0: No hemorrhage apparent in CT. - Grade 1: Minimal hemorrhage without intraventricular hemorrhage (IVH). - Grade 2: Thin or diffusely thin (\<1mm) hemorrhage with bilateral IVH. - Grade 3: Thick (\> 1 mm) hemorrhage without bilateral IVH. - Grade 4: Thick (\> 1 mm) hemorrhage with bilateral IVH.
Sponsors
Haseki Training and Research Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
\- patients (aged ≥ 18 years) who presented to the emergency department with non-traumatic Subarachnoid Hemorrhage between July 2020 and July 2025
Exclusion criteria
* patients younger than 18 years * patients with missing information * patients with traumatic SAH * patients with subdural or epidural hemorrhage * patients with concurrent ischemic stroke
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Predictive ability of frontal-QRST angle for 28-day mortality | From admission to 28 days | The investigators assessed the predictive ability of frontal-QRST angle in determining 28-day mortality. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Predictive ability of frontal-QRST angle for neurological survival | From admission to 28 days | The investigators assessed the predictive ability of frontal-QRST angle in determining neurological survival |
Countries
Turkey (Türkiye)
Outcome results
None listed