From 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).
Eur J Anaesthesiol. 2023 Jun 1;40(6):442-449. doi: 10.1097/EJA.0000000000001829. Epub 2023 Apr 12.
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.
To study the prevalence of cardiac dysfunction (as assessed by echocardiography) in patients with SAH and its effect on clinical outcomes.
Systematic review of observational studies.
We performed a systematic search over the last 20 years on MEDLINE and EMBASE databases.
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.
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.
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.
蛛网膜下腔出血（SAH）是一种危及生命的疾病，伴有脑损伤。此外，SAH 与儿茶酚胺的大量释放有关，儿茶酚胺可能促进心脏损伤和功能障碍，可能导致血流动力学不稳定，进而可能影响患者的预后。
研究蛛网膜下腔出血患者心脏功能障碍（通过超声心动图评估）的患病率及其对临床结局的影响。
对观察性研究进行系统评价。
我们在过去 20 年中对 MEDLINE 和 EMBASE 数据库进行了系统搜索。
报告重症监护病房收治的成人 SAH 患者超声心动图结果的研究。主要结局为院内死亡率和根据是否存在心脏功能障碍的不良神经结局。
我们共纳入了 23 项研究（4 项回顾性研究），共纳入 3511 例患者。心脏功能障碍的累积频率为 21%（725 例），大多数研究报告了区域性壁运动异常（63%）。由于临床结局数据报告的异质性，仅对院内死亡率进行了定量分析。心脏功能障碍与更高的院内死亡率相关[比值比 2.69（1.64 至 4.41）；P ＜0.001；I2 = 63%]。证据评估的 GRADE 等级表明证据确定性非常低。
约五分之一的蛛网膜下腔出血患者会出现心脏功能障碍，这似乎与更高的院内死亡率相关。心脏和神经数据报告的一致性不足，降低了该领域研究的可比性。
