Raised levels of troponin, NT-PRO-BNP and ECG changes – could it be a subarachnoid hemorrhage? Meta-analysis and current literature review

Objective: We reviewed current state of the art literature published on the subject of biological markers and EKG changes indicating the possibility of a subarachnoid hemorrhage. There is an increasing incidence and prevalence of cases with subarachnoid hemorrhage due to current lifestyle changes in general population.
strong>Methods: We queried international database PubMed for recent articles using the syntax: ((subarachnoid [Title/Abstract]) AND hemorrhage [Title/Abstract]) AND cardiac [Title/Abstract]; and restricted with fil-ters: free full text; publication date from 2012/01/01 to 2018/04/01; humans. Afterwards we selected 40 articles tackling the aspects of raised levels of troponin, NT-proBNP and ECG changes in cases with subarachnoid hemorrhage.
Results: Our analysis of the selected articles revealed that 20 are patient population studies, 16 are case series, 2 are management guidelines and 2 underline physio-logical and pathological interactions in the brain- heart axis. From the case series we retain the rather exotic scenario of secondary Takotsubo cardiomyopathy and the dramatic scenario of misdiagnosing the cerebral hemorrhage and administering treatment for coronary syndromes. From the 20 patient population studies would result a cumulated meta-analysis of 2735 cases with subarachnoid hemorrhage with variations due to study designs: prospective or retrospective studies; focus on specific biological markers or dynamic ECG changes.
Conclusions: T he most frequent ECG changes were prolonged QTc, ST depression, atria fibrillation and T wave inversion. There is a significant statistical association between troponin and NTproBNP elevation in cases with subarachnoid hemorrhage. There is still the debate if and when to cerebral CT scan these cases in order to confirm the dynamic evolution of the suba-rachnoid hemorrhage. Close cooperation between car-diologist, intensive care specialist, neurosurgeon and radiologist is the answer to the complex interplay of the neuroendocrine system and catecholamine release; in order to discern which the first was the subarachnoid hemorrhage or the cardiac event.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)