Page 20 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage
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Chapter 2
Abstract
Impact of cardiac complications after aneurysmal subarachnoid hemorrhage (SAH) remains controversial. We performed a meta-analysis to assess whether ECG changes, myocardial damage, or echocardiographic wall motion abnormalities (WMAs), are related to death, poor outcome (death or dependency) or delayed cerebral ischemia (DCI) after SAH.
Methods: Articles on cardiac abnormalities after aneurysmal SAH that met predefined criteria, and were published between 1960 and 2007 were retrieved. We assessed quality of reports, and extracted data on patient characteristics, cardiac abnormalities, and outcome measurements. Poor outcome was defined as death or dependence by the Glasgow Outcome Scale (dichotomized at ≤ 3), or the modified Rankin scale (dichotomized at >3). If studies used another dichotomy or another outcome scale, we used the numbers of patients with poor outcome provided by the authors. We calculated pooled Relative Risks (RR) with corresponding 95% CI for the relation between cardiac abnormalities and outcome measurements.
Results: We included 25 studies (16 prospective), totaling 2690 patients (mean age 53 years; 35% men). Mortality was related with WMAs (RR:1.9), elevated troponin (RR:2.0) and BNP levels (RR:11.1), tachycardia (RR:3.9), Q waves (RR:2.9), ST- depression (RR:2.1), T-wave abnormalities (RR:1.8), and bradycardia (RR:0.6). Poor outcome was associated with elevated troponin (RR:2.3), CK-MB levels (RR:2.3), and ST-depression (RR:2.4). Occurrence of DCI was associated with WMAs (RR:2.1), elevated troponin (RR:3.2), CK-MB (RR:2.9), and BNP levels (RR:4.5) and ST-depression (RR:2.4). All RR were significant.
Conclusion: Markers for cardiac damage and dysfunction are associated with an increased risk of death, poor outcome, and DCI after SAH. Future research should establish whether these cardiac abnormalities are independent prognosticators and should be directed towards pathophysiological mechanisms and potential treatment options.
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