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Published on: August 30, 2020
Cardiac dysfunction in patients affected by subarachnoid haemorrhage affects in-hospital mortality: A systematic
Antonio Messina1, Yaroslava Longhitano, Christian Zanza
1From the IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (AM, LC, FV, MC), Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (AM, MC), Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA (YL, CZ), IRCCS Ospedale Policlinico San Martino (CR), Dipartimento di Medicina E Chirurgia, Universita' Degli Studi di Perugia, Perugia (GC) and Department of Anaesthesia and Intensive Care, A.O.U. 'Policlinico-San Marco', Catania, Italy (FS).
Insights
Subarachnoid hemorrhage (SAH) can cause cardiac dysfunction in about 21% of patients. This cardiac dysfunction is linked to increased in-hospital mortality, though evidence certainty is low.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) is a critical neurological condition.
- SAH is associated with catecholamine release, potentially causing cardiac injury and hemodynamic instability.
- Cardiac dysfunction following SAH can significantly impact patient outcomes.
Approach:
- A systematic review of observational studies published over the last 20 years was conducted.
- MEDLINE and EMBASE databases were searched for relevant studies.
- Included studies focused on adult patients with SAH requiring intensive care, assessing cardiac dysfunction via echocardiography.
Key Points:
- The review included 23 studies with 3511 patients.
- Cardiac dysfunction was identified in 21% of SAH patients, primarily as regional wall motion abnormalities.
- Cardiac dysfunction was associated with a 2.69-fold increased risk of in-hospital mortality (OR 2.69; 95% CI 1.64-4.41).
Conclusions:
- Approximately one in five patients with SAH experiences cardiac dysfunction.
- Cardiac dysfunction in SAH patients is linked to a higher likelihood of in-hospital death.
- Lack of consistent reporting on cardiac and neurological outcomes limits study comparability and certainty of evidence (GRADE: very low).
Background:
Subarachnoid haemorrhage (SAH) is a life-threatening condition with associated brain damage. Moreover, SAH is associated with a massive release of catecholamines, which may promote cardiac injury and dysfunction, possibly leading to haemodynamic instability, which in turn may influence a patient's outcome.
Objectives:
To study the prevalence of cardiac dysfunction (as assessed by echocardiography) in patients with SAH and its effect on clinical outcomes.
Design:
Systematic review of observational studies.
Data Sources:
We performed a systematic search over the last 20 years on MEDLINE and EMBASE databases.
Eligibility Criteria:
Studies reporting echocardiography findings in adult patients with SAH admitted to intensive care. Primary outcomes were in-hospital mortality and poor neurological outcome according to the presence or absence of cardiac dysfunction.
Results:
We included a total of 23 studies (4 retrospective) enrolling 3511 patients. The cumulative frequency of cardiac dysfunction was 21% (725 patients), reported as regional wall motion abnormality in the vast majority of studies (63%). Due to the heterogeneity of clinical outcome data reporting, a quantitative analysis was carried out only for in-hospital mortality. Cardiac dysfunction was associated with a higher in-hospital mortality [odds ratio 2.69 (1.64 to 4.41); P < 0.001; I2 = 63%]. The GRADE of evidence assessment resulted in very low certainty of evidence.
Conclusion:
About one in five patients with SAH develops cardiac dysfunction, which seems to be associated with higher in-hospital mortality. The consistency of cardiac and neurological data reporting is lacking, reducing the comparability of the studies in this field.
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