Related Experiment Video
Updated: May 16, 2025
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Prognostic value of elevated cardiac troponin in aneurysmal subarachnoid hemorrhage: a systematic review and
Jiahui Zhao1, Shujuan Gu1, Xudong Zhao1
1Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Insights
Elevated cardiac troponin (cTn) levels in subarachnoid hemorrhage (SAH) patients indicate a higher risk of mortality and adverse outcomes. Early monitoring and intervention are crucial for those with elevated cTn following SAH.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) is a critical neurological condition with high mortality and disability rates.
- Elevated serum cardiac troponin (cTn) levels have been observed to correlate with poor prognosis in SAH patients.
- Previous studies on this correlation had limitations, including small sample sizes and lack of differentiation between traumatic and aneurysmal SAH.
Purpose of the Study:
- To systematically analyze the prognostic value of elevated cardiac troponin (cTn) levels in subarachnoid hemorrhage (SAH).
- To provide a clinical reference by reviewing all existing studies on cTn and SAH outcomes.
- To differentiate the prognostic implications of elevated cTn in aneurysmal SAH (aSAH) versus total SAH (toSAH).
Main Methods:
- Systematic review of studies on cTn and SAH published before December 2023, sourced from major scientific databases.
- Quality assessment of included studies using the Newcastle-Ottawa Scale and methodological quality assessment using PRISMA and AMSTAR guidelines.
- Analysis of pooled effect sizes for total SAH (toSAH) and aneurysmal SAH (aSAH) groups using R studio and Stata 14.0.
Main Results:
- Elevated cTn levels were found in 24.55% of toSAH patients (33 studies) and 25.0% of aSAH patients.
- In aSAH, elevated cTn significantly correlated with increased in-hospital mortality (OR=2.51) and 3-month mortality (OR=2.27).
- Elevated cTn was associated with increased risks of disturbed consciousness, delayed cerebral ischemia (DCI), physical disability, cardiac dysfunction, arrhythmias, abnormal ventricular wall motion, and neurogenic pulmonary edema.
Conclusions:
- Elevated cardiac troponin (cTn) levels are a significant indicator of poor prognosis in subarachnoid hemorrhage (SAH), especially in aneurysmal SAH (aSAH).
- Patients with SAH and elevated cTn levels face increased risks of adverse events and poorer outcomes.
- Clinicians should prioritize close monitoring and consider early interventions for SAH patients presenting with elevated cTn levels.
Objective:
Subarachnoid hemorrhage (SAH) is a common intracranial hemorrhagic condition associated with a high mortality rate and significant disability due to serious complications. In clinical practice, we have observed that elevated serum cardiac troponin (cTn) levels correlate with a poor prognosis in SAH. Although some studies have reported this correlation, these studies had small sample sizes and did not make a distinction between traumatic SAH and aneurysmal SAH. Accordingly, we aimed to systematically analyze the prognostic evaluation value of elevated cTn levels in SAH by reviewing all existing studies to provide a clinical reference.
Methods:
We selected studies on cTn and SAH from PubMed, Medline, Embase, Web of Science, Cochrane Library, and Clinical Trails databases published before December 2023. The Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. PRISMA and AMSTAR guidelines were followed to assess the methodological quality of the systematic review. We divided the included studies into two groups: aneurysmal subarachnoid hemorrhage (aSAH) group and total subarachnoid hemorrhage (toSAH) group. The total subarachnoid hemorrhage (toSAH) group included aSAH and traumatic SAH studies for analysis. The pooled effect size was calculated using R studio and Stata 14.0.
Results:
In the toSAH group, 1,559 out of 6,349 (24.55%) SAH patients from 33 studies exhibited elevated cTn levels, while 25.0% in the aSAH group also exhibited similar results. In the aSAH group, high levels of cTn were significantly related to increased mortality both in the hospital [OR = 2.51, 95%CI (1.95, 3.23)] and 3 months later [OR = 2.27, 95%CI (1.47, 3.49)]. An increased incidence of disturbance of consciousness [OR = 2.28, 95%CI (1.41, 3.67)], delayed cerebral ischemia (DCI) [OR = 1.99, 95%CI (1.40, 2.83)], physical disability [OR = 2.39, 95%CI (1.79, 3.20)], cardiac dysfunction [OR = 3.97, 95%CI (2.95, 5.33)], arrhythmias [OR = 4.87, 95%CI (2.52, 9.41)], abnormal ventricular wall motion [OR = 8.20, 95%CI (3.70, 18.18)], and neurogenic pulmonary edema [OR = 2.76, 95%CI (1.85, 4.12)] were associated with elevated cTn levels. In the total SAH patient group, the results were further validated.
Conclusion:
Elevated cTn levels were associated with a poor prognosis and an increased risk of adverse events, particularly in aneurysmal SAH. Clinicians should prioritize monitoring SAH patients with elevated cTn levels and consider early intervention strategies.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD42023433744, identifier: CRD42023433744.
More Related Videos
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...