title: Clinical presentations and outcomes of Takotsubo syndrome in the setting of subarachnoid hemorrhage: A systematic review and meta-analysis.
abstract: BACKGROUND
  Evidence remains inconsistent regarding the incidence and prognosis of Takotsubo syndrome in the setting of subarachnoid hemorrhage. Thus, we aimed to evaluate the clinical presentation and in-hospital mortality of these patients.
  
  
  METHODS
  A systematic review of the electronic databases was conducted for studies involving patients with spontaneous subarachnoid hemorrhage and concomitant findings of classical Takotsubo syndrome on transthoracic echocardiogram. A meta-analysis was conducted for the primary outcome of in-hospital mortality using the Mantel-Haenszel method for fixed effects and the DerSimonian and Laird method for random effects, with 95% confidence interval and a p-value <0.05 for statistical significance.
  
  
  RESULTS
  Ten studies were retrieved with a total of 157 patients presenting with classical Takotsubo syndrome, representing 4.4% of the subarachnoid hemorrhage total population. The overall incidence of in-hospital mortality was 30% in the patients who developed Takotsubo syndrome. Meta-analysis illustrated a significant increase in the odds of in-hospital mortality for the Takotsubo syndrome patients by fixed effects model (odds ratio 2.6, 95% confidence interval 1.16-5.85, p=0.02, I2=39%), with a trend towards increased risk of in-hospital mortality by random effects model (odds ratio 3.00, 95% confidence interval 0.90-9.77, p = 0.07).
  
  
  CONCLUSIONS
  The incidence of Takotsubo syndrome in patients with spontaneous subarachnoid hemorrhage seems to be high with a trend towards higher risk of in-hospital mortality in those patients. Thus, patients presenting with subarachnoid hemorrhage might benefit from a comprehensive cardiac evaluation upon presentation for early detection and proper triage of this high-risk population.
authors.affiliation: 1 Department of Medicine, University of Florida, Gainesville, USA.
authors.forename: Akram Y
authors.initials: AY
authors.lastname: Elgendy
authors.affiliation: 2 Division of Cardiovascular Medicine, University of Florida, Gainesville, USA.
authors.forename: Islam Y
authors.initials: IY
authors.lastname: Elgendy
authors.affiliation: 3 Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, USA.
authors.forename: Hend
authors.initials: H
authors.lastname: Mansoor
authors.affiliation: 2 Division of Cardiovascular Medicine, University of Florida, Gainesville, USA.
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Mahmoud
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D015897:Comorbidity; D004452:Echocardiography; D014943:Global Health; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D017052:Hospital Mortality; D006801:Humans; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000453:epidemiology*; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed
keywords: Subarachnoid hemorrhage; Takotsubo syndrome; apical ballooning; meta-analysis