Sex-related cardiac complications and their association on functional outcome in patients with aneurysmal subarachnoid hemorrhage: a retrospective study

Cardiac complications are common following aneurysmal subarachnoid hemorrhage (aSAH). Sex-related differences in the development of these complications and their association with short- and long-term outcome remain insufficiently understood. This retrospective study included all consecutive adult patients with aSAH who were treated at the neurocritical care unit (NCCU) at the University Hospital of Zurich between January 2016 and December 2022. Demographics, severity scores, laboratory and radiological findings as well as functional outcomes and mortality at different time points were analyzed. Furthermore, well-defined cardiac complications which arose during the NCCU stay were investigated. Data were dichotomized by sex, presence of cardiac complications and outcome (favorable vs. unfavorable). Based on the results of the univariate analysis and clinical relevance, multivariable logistic regression models were constructed to evaluate the simultaneous effects of multiple predictors on NCCU-mortality and functional outcome at 3 and 12 months. 387 patients were included (females n = 251 (64.9%)). Cardiac complications occurred frequently (n = 250 patients (64.6%)) in the acute phase and were more frequent in women (70.5% vs 53.7%, respectively, p = 0.001), in particular arrhythmic disorders (p < 0.001) and myocardial injuries (p = 0.045). With regard to long-term outcome, female sex and the development of cardiac complications were independently associated with an unfavorable outcome. Although female patients with aSAH may benefit from more intensive cardiac monitoring due to higher frequency of cardiac complications, our analysis also suggests that male patients who develop cardiac complications had a higher risk of an unfavorable long-term outcome than their female counterpart. Cardiac complications following aSAH are common in the acute phase. Women are more commonly affected, in particular from arrhythmias and myocardial injuries. Moreover, our data suggests that the acute development of cardiac complications and female sex may have an independent association with long-term unfavorable outcome. Male patients who develop cardiac complications have a higher risk of an unfavorable long-term outcome than their female counterpart.