Takotsubo cardiomyopathy in post-traumatic brain injury: A systematic review of diagnosis and management

Gruhl, Sabrina Lasini; Su, Jun; Chua, Wei Chong; Tay, Kon Voi

doi:10.1016/j.clineuro.2021.107119

Cited by 6 publications

(6 citation statements)

References 35 publications

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“…In contrast to a recent systematic review of case reports and cohort studies showing TTC predominantly in head injury incidents with an average GCS of 5 [29], the analysis of the NTDB data shows TTC in trauma patients predominantly with GGS > 13, more often with extremity trauma and with differences in sex distribution on ISS, GCS levels, and rate of mechanical ventilation. This discrepancy in frequency suggests that TTC in the trauma population may be related to high levels of activation of the brain-heart axis at both ends of the severity spectrum where emotional and physical stressors play different roles in the pathogenesis of the disorder.…”

Section: Injury Characteristicscontrasting

confidence: 86%

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Takotsubo Cardiomyopathy and Trauma: The Role of Injuries as Physical Stressors

Fernández¹,

Narveson²,

Walters³

et al. 2022

Cureus

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Introduction: Physical stressors are common predisposing factors for takotsubo cardiomyopathy (TTC). However, the role of traumatic injuries in TTC has not been well defined. This study describes the characteristics of TTC in the broad spectrum of traumatic injuries using the information available in the National Trauma Data Bank (NTDB).Materials and methods: This retrospective study analyzed trauma patients ≥ 18 years old in the NTDB, from 2007 to 2018, with a diagnosis of TTC.Results: A total of 95 TTC diagnoses were found. The median age was 68 years old (interquartile range: 55-80). Patients were predominantly female (67.4%), white (88.4%), and sustained blunt mechanisms of injury (90.5%). Penetrating trauma was most common in males (16%). Most diagnoses were related to extremity trauma (53.7%), followed by head injury (26.3%). The most common severity scores were Glasgow Coma Scale (GCS) > 13 or < 8, and Injury Severity Score (ISS) < 15 or > 25. Males more commonly presented with GCS < 8 (68%), ISS > 25 (33%), high intensive care unit (ICU) admission rate (77.4%), and mechanical ventilation (51.6%). The median duration of the mechanical ventilation was eight days for both sexes. The ICU length of stay (LOS) was six days with a hospital LOS of nine days and a trend toward a longer LOS in males. The in-hospital mortality rate was 11.7% for both sexes.Conclusions: TTC in traumatic injuries is common at both ends of the severity spectrum and has different sex distribution. TTC patients are predominantly females and have more commonly extremity trauma than head injury. Males are more severely injured and under mechanical ventilation.

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Section: Injury Characteristicscontrasting

confidence: 86%

“…This distribution of injuries with TCC closely follows the 2016 NTDB report for injury by AIS body region except for a lower rate of facial injuries [28]. We think this is an interesting finding as the literature previously described TTC in trauma patients predominantly affected by traumatic brain injury [29].…”

Section: Injury Characteristicssupporting

confidence: 85%

Takotsubo Cardiomyopathy and Trauma: The Role of Injuries as Physical Stressors

Fernández¹,

Narveson²,

Walters³

et al. 2022

Cureus

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“…Low levels of serum albumin are also an overlooked predictor of cardiovascular disease 13 , and it has been shown that hypoalbuminemia is common in patients with acute heart failure and is independently associated with an increased 1-year mortality rate in these hospitalized patients 24 . And since myocardial dysfunction is one of the complications in patients with craniocerebral trauma 25 , predicting the occurrence of hypoalbuminemia in patients with TBI will not only allow clinicians to keep an eye on the protein levels of their patients, but also raise the alertness for cardiac dysfunction in such patients.…”

Section: Discussionmentioning

confidence: 99%

Radiomics Features on Computed Tomography Combined with Clinical Factors Predicting Hypoproteinemia in Patients with Traumatic Brain Injury

Li,

Jiang,

Zhang

et al. 2023

Preprint

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Background Traumatic brain injury (TBI) is a major cause of death and disability in all age groups, placing a heavy burden on society and families, serum albumin levels have a significant impact on mortality and length of hospitalization patients. This study was made to develop a predictive model based on Computed Tomography (CT) and clinical parameters to explore the predictable power of the model in the development of hypoproteinemia with TBI patients. Methods A total of 72 TBI patients were prospectively recruited and confirmed as hypoproteinemia in 26 cases. A cranial CT and clinical parameters such as age, gender, admission Glasgow score were collected to establish the clinical model. The least absolute shrinkage and selection operator (LASSO) was applied to extract radiological features. Then a total of five different machine learning methods (RF, SVM, GNB, XGB, KNN) were used to establish the prediction model of radiomics. Finally, a combined model: clinical-radiological was constructed. The average area under the curve (AUC) were used to evaluate the performance of each model. Results Comparing these three different models, we found that the radiomic models combined with clinical parameters showed the best performance, which had an AUC with 0.8704 compared with clinical model only AUC = 0.8512 and radiomics model only AUC = 0.7040, respectively. Conclusions The model of radiomics features combined with clinical parameters is superior to the radiomics model and clinical model alone, and the model of radiomics combined with clinical parameters is a useful tool for predicting the occurrence of hypoproteinemia in patients with traumatic brain injury.

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“…Myocardial dysfunctions, such as NSC, are well-established complications of severe brain injury. 4,129 On the other hand, TTC is associated with acute and severe LV dysfunction, which could contribute to LV thrombus formation-with potential cardioembolic complications, such as cardioembolic stroke. 15 The incidence, however, of LV thrombus formation and related embolic complications varies between studies.…”

Section: Ischemic Stroke In Patients With Nscmentioning

confidence: 99%

The Heart Is at Risk: Understanding Stroke-Heart-Brain Interactions with Focus on Neurogenic Stress Cardiomyopathy—A Review

Ziaka¹,

Exadaktylos

2023

J Stroke

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In recent years, it has been convincingly demonstrated that acute brain injury may cause severe cardiac complications-such as neurogenic stress cardiomyopathy (NSC), a specific form of takotsubo cardiomyopathy. The pathophysiology of these brain-heart interactions is complex and involves sympathetic hyperactivity, activation of the hypothalamic-pituitary-adrenal axis, as well as immune and inflammatory pathways. There have been great strides in our understanding of the axis from the brain to the heart in patients with isolated acute brain injury and more specifically in patients with stroke. On the other hand, in patients with NSC, research has mainly focused on hemodynamic dysfunction due to arrhythmias, regional wall motion abnormality, or left ventricular hypokinesia that leads to impaired cerebral perfusion pressure. Comparatively little is known about the underlying secondary and delayed cerebral complications. The aim of the present review is to describe the stroke-heart-brain axis and highlight the main pathophysiological mechanisms leading to secondary and delayed cerebral injury in patients with concurrent hemorrhagic or ischemic stroke and NSC as well as to identify further areas of research that could potentially improve outcomes in this specific patient population.

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Takotsubo cardiomyopathy in post-traumatic brain injury: A systematic review of diagnosis and management

Cited by 6 publications

References 35 publications

Takotsubo Cardiomyopathy and Trauma: The Role of Injuries as Physical Stressors

Takotsubo Cardiomyopathy and Trauma: The Role of Injuries as Physical Stressors

Radiomics Features on Computed Tomography Combined with Clinical Factors Predicting Hypoproteinemia in Patients with Traumatic Brain Injury

The Heart Is at Risk: Understanding Stroke-Heart-Brain Interactions with Focus on Neurogenic Stress Cardiomyopathy—A Review

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