Page 27 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage
A total of 2690 patients were included. In the 21 studies where gender distribution
was reported, the mean percentage of men was 35%. Mean age varied from 36 to 59
years, with a weighted mean of 53 years (21 studies).
Sixteen studies were prospective, nine were retrospective. The STROBE score varied
from 11 to 20 with a median of 17. In 15 studies, data on the neurological condition
on admission were available. The proportion of patients with a poor neurological 2 condition on admission varied from 23% to 68%, with a mean of 49% (15 studies).
The follow-up duration (for outcome assessment) varied from follow-up during hospital stay (14 studies) to six months follow-up. The proportion of patients who died during the observation period varied from 8% to 38% with a mean of 22% (18 studies). The percentage of patients with poor outcome varied from 16% to 63% with a mean of 46% (seven studies). Finally, the percentage of patients with DCI varied from 8% to 44% with a mean of 23% (ten studies). As stated earlier, the definition of DCI varied. 7scored temporary focal neurological signs as DCI, 8, 9equated imaging signs of vasospasm with DCI, 10used neurological deterioration with imaging evidence of spasms, 11-14 used neurological deterioration with exclusion of other causes (using CT), 15 used neurological deterioration and imaging evidence of spasms or CT evidence of infarction. 16did not use a clear definition (clinical vasospasm).
Table 2 shows the proportions of patients with cardiac abnormalities: WMAs varied from 13% to 31% of the patients with a mean of 22% (nine studies). Diastolic dysfunction was reported in one study, in 71% of patients. Elevated troponin levels were reported in 21% to 50% of patients with a mean of 34% (six studies). CK-MB presence varied from 13% to 60% with a mean of 33% (six studies). Three studies reported elevated BNP levels, but each used different criteria for BNP elevation. Using these different criteria, elevated BNP levels were found between 9% and 100%.
25