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Medline ® Abstract for Reference 27

of 'Neurogenic pulmonary edema'

ECG abnormalities predict neurogenic pulmonary edema in patients with subarachnoid hemorrhage.
Chen WL, Huang CH, Chen JH, Tai HC, Chang SH, Wang YC
Am J Emerg Med. 2016;34(1):79. Epub 2015 Sep 25.
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 logisticregression 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.
Department of Emergency Medicine, Cathay General Hospital, Taipei 106, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei 242, Taiwan. Electronic address: weilung.chen@msa.hinet.net.