• Impact of preadmission beta blockers and cardiac dysfunction on the incidence of cerebral vasospasm and mortality in aneurysmal subarachnoid hemorrhage

    Final Number:

    Nohra Chalouhi MD; Cory Donovan Bovenzi; Eliza Claire Anderson; Guilherme Barros; Adam Reese; Stavropoula I. Tjoumakaris MD; Pascal Jabbour MD; Robert H. Rosenwasser MD, FACS, FAHA; Fred Rincon

    Study Design:

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2015 Annual Meeting

    Introduction: Vasospasm is a frequent complication of aneurysmal subarachnoid hemorrhage (SAH), with a significant impact on disease course. The purpose of the present study was to assess the impact of preadmission beta-blockers and cardiac dysfunction on the incidence of vasospasm and mortality following SAH.

    Methods: The study population included 210 consecutive patients treated for aneurysmal SAH at Jefferson Hospital for Neuroscience. The occurrence of vasospasm was assessed by serial transcranial Doppler and/or the need for endovascular intervention for medically refractory vasospasm.

    Results: The proportion of patients with any mean flow velocity >120 cm/sec was 22% in patients taking prehospital beta-blockers versus 59% in those not taking prehospital beta-blockers (p=0.003). In multivariate analysis, preadmission beta-blockers (OR 4.5; p=0.002) and lower Hunt and Hess grades (OR 3.9; p<0.001) negatively predicted vasospasm. Fourteen patients required an endovascular intervention for medically refractory vasospasm; none were taking prehospital beta-blockers. In multivariate analysis, decreasing ejection fraction (OR 3.9; p=0.05) independently predicted medically refractory vasospasm. The rate of in-hospital mortality was 47.4% in patients with left ventricular motion wall abnormality versus 14.8% in those without (p<0.001). In multivariate analysis, left ventricle motion wall abnormality (OR 2.7; p=0.002) and decreasing ejection fraction (OR 1.1; p=0.05) were independent predictors of in-hospital mortality.

    Conclusions: The results of this study suggest that preadmission beta-blockers are associated with decreased incidence of cerebral vasospasm in patients with aneurysmal SAH. Beta-blockers may be a promising therapeutic avenue for vasospasm and may need to be continued/started in patients with SAH. Left ventricular dysfunction was associated with medically refractory vasospasm and in-hospital mortality.

    Patient Care: Beta blockers may be an unrecognized treatment for cerebral vasospasm. Also, cardiac dysfunction needs to be recognized as a major determinant of outcome and acted upon in the setting of SAH

    Learning Objectives: 1)To describe the relationship between cardiac dysfunction and outcome in the setting of SAH 2) To discuss the relationship between preadmission betablockers and outcomes in SAH


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