Cardiac Injury After Traumatic Brain Injury: Clinical Consequences and Management

Coppalini, Giacomo; Salvagno, Michele; Peluso, Lorenzo; Bogossian, Elisa Gouvêa; Cornejo, Armin Quispe; Annoni, Filippo; Taccone, Fabio Silvio

doi:10.1007/s12028-023-01777-3

Cited by 7 publications

(6 citation statements)

References 75 publications

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“…Understanding the epidemiology of myocardial injury after TBI may provide useful evidence to monitor cardiac biomarkers and echocardiograms in patients with TBI for more timely and accurate treatment. 5 17 In another part of our work, we will reexamine the relationship between myocardial injury and in-hospital mortality after TBI, which may provide evidence or direction for developing a prognosis model for TBI. As an update and expansion to the previous meta-analysis 9 , many more studies published recently will be included through our comprehensive search, and new analysis methods such as subgroup analysis and meta-regression will be introduced in our systematic review and meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The proposed mechanisms behind cTn elevation following TBI involve massive catecholamine release, overstimulation of sympathetic nerve activity and activation of the adrenal glands, resulting in myocardial injury and cardiac dysfunction. 5 In recent studies, elevated cTn levels have been reported as an independent risk factor for in‐hospital mortality of TBI. 7 8 In addition, Krishnamoorthy et al have found that early myocardial injury characterised by elevated high-sensitivity cTn was associated with poor 6-month clinical outcomes following moderate to severe TBI.…”

Section: Introductionmentioning

confidence: 99%

“…Various types of cardiovascular disturbances were found in patients with TBI, including myocardial injury, left and/or right ventricular dysfunction, electrocardiography abnormalities and cardiac arrhythmias. 5 Among them, ischaemic or non-ischaemic myocardial injury, defined by cardiac troponin (cTn) elevation >99th percentile, is a relatively common cardiovascular complication, with a reported prevalence of nearly 30% in moderate to severe patients with TBI. 6 However, within the current literature, there is no uniform reflection of the incidence of myocardial injury characterised by cTn elevation after TBI.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and associated in-hospital mortality of myocardial injury characterised by elevated cardiac troponin in adult patients with traumatic brain injury: protocol for a systematic review and meta-analysis

Tang,

Yu,

Zhang

et al. 2024

BMJ Open

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IntroductionMyocardial injury is a relatively common complication of traumatic brain injury (TBI). However, the incidence and clinical impact of myocardial injury characterised by elevated cardiac troponin (cTn) levels after TBI are still poorly known. The objective of our study is to assess the global incidence of myocardial injury characterised by elevated cTn in adult patients with TBI and its association with in-hospital mortality.Methods and analysisThe protocol of our systematic review and meta-analysis is performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We will search the Medline, Embase, Cochrane Library, Scopus and Web of Science databases from inception to 1 January 2024, for observational studies in any language that reported the incidence of elevated cTn and/or in-hospital mortality associated with elevated cTn among adult patients with TBI. Two reviewers will independently assess study eligibility, extract the data and assess the risk of bias. ORs and 95% CIs will be used with a random-effects or fixed-effects model according to the estimated heterogeneity among studies assessed by the I2index. We will perform a quantitative synthesis for the incidence of elevated cTn and in-hospital mortality data. If sufficient data are available, we will perform subgroup analysis and meta-regression to address the heterogeneity. In addition, we will perform a narrative analysis if quantitative synthesis is not appropriate.Ethics and disseminationEthics approval was not required for this study. We intend to publish our findings in a high-quality, peer-reviewed journal.PROSPERO registration numberCRD42023454686.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence and associated in-hospital mortality of myocardial injury characterised by elevated cardiac troponin in adult patients with traumatic brain injury: protocol for a systematic review and meta-analysis

Tang,

Yu,

Zhang

et al. 2024

BMJ Open

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“…Cardiac troponin and beta-natriuretic peptide: Due to the heterogeneity in the reported ranges of cTnI [20,[23][24][25][26][27][28][29][30][31][32] and BNP [33][34][35][36] across the ABI types, we elected to categorize the cTnI and BNP values obtained in our cohort into four quartiles as shown in Table 1. Interestingly, the ABI types demonstrated different cut-offs for the median and the quartiles for cTnI (TBI expressed lower cTnI ranges, while SAH demonstrated the highest).…”

Section: Definition Of Cardiac Abnormalitiesmentioning

confidence: 99%

Early Cardiac Evaluation, Abnormal Test Results, and Associations with Outcomes in Patients with Acute Brain Injury Admitted to a Neurocritical Care Unit

Lele,

Liu,

Kunapaisal

et al. 2024

JCM

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Background: to examine factors associated with cardiac evaluation and associations between cardiac test abnormalities and clinical outcomes in patients with acute brain injury (ABI) due to acute ischemic stroke (AIS), spontaneous subarachnoid hemorrhage (SAH), spontaneous intracerebral hemorrhage (sICH), and traumatic brain injury (TBI) requiring neurocritical care. Methods: In a cohort of patients ≥18 years, we examined the utilization of electrocardiography (ECG), beta-natriuretic peptide (BNP), cardiac troponin (cTnI), and transthoracic echocardiography (TTE). We investigated the association between cTnI, BNP, sex-adjusted prolonged QTc interval, low ejection fraction (EF < 40%), all-cause mortality, death by neurologic criteria (DNC), transition to comfort measures only (CMO), and hospital discharge to home using univariable and multivariable analysis (adjusted for age, sex, race/ethnicity, insurance carrier, pre-admission cardiac disorder, ABI type, admission Glasgow Coma Scale Score, mechanical ventilation, and intracranial pressure [ICP] monitoring). Results: The final sample comprised 11,822 patients: AIS (46.7%), sICH (18.5%), SAH (14.8%), and TBI (20.0%). A total of 63% (n = 7472) received cardiac workup, which increased over nine years (p < 0.001). A cardiac investigation was associated with increased age, male sex (aOR 1.16 [1.07, 1.27]), non-white ethnicity (aOR), non-commercial insurance (aOR 1.21 [1.09, 1.33]), pre-admission cardiac disorder (aOR 1.21 [1.09, 1.34]), mechanical ventilation (aOR1.78 [1.57, 2.02]) and ICP monitoring (aOR1.68 [1.49, 1.89]). Compared to AIS, sICH (aOR 0.25 [0.22, 0.29]), SAH (aOR 0.36 [0.30, 0.43]), and TBI (aOR 0.19 [0.17, 0.24]) patients were less likely to receive cardiac investigation. Patients with troponin 25th–50th quartile (aOR 1.65 [1.10–2.47]), troponin 50th–75th quartile (aOR 1.79 [1.22–2.63]), troponin >75th quartile (aOR 2.18 [1.49–3.17]), BNP 50th-75th quartile (aOR 2.86 [1.28–6.40]), BNP >75th quartile (aOR 4.54 [2.09–9.85]), prolonged QTc (aOR 3.41 [2.28; 5.30]), and EF < 40% (aOR 2.47 [1.07; 5.14]) were more likely to be DNC. Patients with troponin 50th–75th quartile (aOR 1.77 [1.14–2.73]), troponin >75th quartile (aOR 1.81 [1.18–2.78]), and prolonged QTc (aOR 1.71 [1.39; 2.12]) were more likely to be associated with a transition to CMO. Patients with prolonged QTc (aOR 0.66 [0.58; 0.76]) were less likely to be discharged home. Conclusions: This large, single-center study demonstrates low rates of cardiac evaluations in TBI, SAH, and sICH compared to AIS. However, there are strong associations between electrocardiography, biomarkers of cardiac injury and heart failure, and echocardiography findings on clinical outcomes in patients with ABI. Findings need validation in a multicenter cohort.

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“…Extracranial complications, particularly cardiac injuries, are frequently encountered in brain injury cases. For example, cardiac issues affect approximately 25-35% of patients with traumatic brain injury, ranging from changes in electrocardiogram readings to more serious conditions such as regional wall motion abnormalities, raised troponin levels and myocardial stunning [7]. Choosing inotropic and vasopressor medications for these patients requires careful consideration of these cardiac factors.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Inotropes and Vasopressors on Cerebral Oxygenation in Patients with Traumatic Brain Injury and Subarachnoid Hemorrhage: A Narrative Review

Salvagno,

Geraldini,

Coppalini

et al. 2024

Brain Sciences

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Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are critical neurological conditions that necessitate specialized care in the Intensive Care Unit (ICU). Managing cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) is of primary importance in these patients. To maintain targeted MAP and CPP, vasopressors and/or inotropes are commonly used. However, their effects on cerebral oxygenation are not fully understood. The aim of this review is to provide an up-to date review regarding the current uses and pathophysiological issues related to the use of vasopressors and inotropes in TBI and SAH patients. According to our findings, despite achieving similar hemodynamic parameters and CPP, the effects of various vasopressors and inotropes on cerebral oxygenation, local CBF and metabolism are heterogeneous. Therefore, a more accurate understanding of the cerebral activity of these medications is crucial for optimizing patient management in the ICU setting.

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Cardiac Injury After Traumatic Brain Injury: Clinical Consequences and Management

Cited by 7 publications

References 75 publications

Incidence and associated in-hospital mortality of myocardial injury characterised by elevated cardiac troponin in adult patients with traumatic brain injury: protocol for a systematic review and meta-analysis

Incidence and associated in-hospital mortality of myocardial injury characterised by elevated cardiac troponin in adult patients with traumatic brain injury: protocol for a systematic review and meta-analysis

Early Cardiac Evaluation, Abnormal Test Results, and Associations with Outcomes in Patients with Acute Brain Injury Admitted to a Neurocritical Care Unit

The Impact of Inotropes and Vasopressors on Cerebral Oxygenation in Patients with Traumatic Brain Injury and Subarachnoid Hemorrhage: A Narrative Review

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