Early Systolic Dysfunction Following Traumatic Brain Injury: A Cohort Study

Abstract

Objective Prior studies have suggested that traumatic brain injury (TBI) may affect cardiac function. Our study aims were to determine the incidence, longitudinal course, and admission risk factors for systolic dysfunction in patients with moderate-severe TBI. Design Prospective cohort study Setting Level 1 trauma center Measurements Transthoracic echocardiogram (TTE) within 1 day and over the first week after moderate-severe TBI; TTE within 1 day after mild TBI (comparison group). Measurements and Main Results Systolic function was assessed by TTE, and systolic dysfunction was defined as fractional shortening (FS) < 25%. Multivariable Poisson regression models examined admission risk factors for systolic dysfunction. Systolic function in 32 patients with isolated moderate-severe TBI and 32 patients with isolated mild TBI (comparison group) was assessed with TTE. Seven (22%) moderate-severe TBI and 0 (0%) mild TBI patients had systolic dysfunction within the first day after injury (p<0.01). All patients with early systolic dysfunction recovered in one week. Younger age (RR 0.87, 95% CI 0.79 – 0.94, for one year increase in age) and lower admission GCS score (RR 0.34, 95% CI 0.20 – 0.58, for one unit increase in GCS) were independently associated with the development of systolic dysfunction among moderate-severe TBI patients. Conclusions Early systolic dysfunction can occur in previously healthy patients with moderate-severe TBI, and it is reversible over the first week of hospitalization. Younger age and lower admission GCS score are independently associated with the development of systolic dysfunction after moderate-severe TBI.

A longitudinal cohort of stress cardiomyopathy screening with speckle-tracking echocardiography after moderate to severe traumatic brain injury

“…Decompressive craniectomy was performed in 8 (8%) patients, and 27 (27%) patients received pentothal in the ICU. The median duration of mechanical ventilation was 9 [5][6][7][8][9][10][11][12][13][14] days and the mean ICU length of stay was 16 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] days. Demographic data and outcome are displayed in Table 1.…”

“…Moreover, the authors studied regional wall motion abnormality index, which bears substantial inter and intra-observer variability [16]. Recently, another monocentric study, evaluated fractional shortening in moderate to severe TBI patients [17]. The authors found a 22% incidence of decreased fractional shortening, exclusively in the group of severe TBI patients.…”

“…Second, this echographic parameter has not been extensively studied in the ICU to assess LV systolic function. In their article, Krishnamoorthy et al [17] do not provide LVEF, rendering questionable the accuracy of LV dysfunction evaluated with fractional shortening. We used STE, which provides robust and sensitive evaluation of LV function [7,18] and was already studied in SAH patients [8].…”

The Prognostic Value of Cardiac Troponin T in Different Age Groups of Traumatic Brain Injury Patients

“…The development of cardiac dysfunction has been veri ed as a risk factor for in-hospital mortality of TBI patients [6]. It has been reported in previous studies that the incidence of cardiac dysfunction after TBI ranged from 13-22.3% [6,[48][49][50]. These studies usually evaluated the cardiac function according to the signs of echocardiogram such as reduced left ventricular ejection fraction and regional wall motion abnormalities.…”

The authors reply

“…We would like to thank Longhi, et al for their thoughtful comments (1) regarding our manuscript recently published in Critical Care Medicine (2), which demonstrated that early systolic dysfunction is common and reversible following moderate-severe traumatic brain injury (TBI). We agree with the authors that TBI-induced cardiac dysfunction likely shares a common underlying pathophysiology with cardiac dysfunction after other neurologic injuries (i.e.…”