Myocardial function at the early phase of traumatic brain injury: a prospective controlled study

Abstract

BackgroundThe concept of brain-heart interaction has been described in several brain injuries. Traumatic brain injury (TBI) may also lead to cardiac dysfunction but evidences are mainly based upon experimental and clinical retrospective studies.MethodsWe conducted a prospective case-control study in a level I trauma center. Twenty consecutive adult patients with severe TBI were matched according to age and gender with 20 control patients. The control group included adult patients undergoing a general anesthesia for a peripheral trauma surgery. Conventional and Speckle Tracking Echocardiography (STE) was performed within the first 24 post-traumatic hours in the TBI group and PRE/PER-operative in the control group. The primary endpoint was the left ventricle ejection fraction (LVEF) measured by the Simpson’s method. Secondary endpoints included the diastolic function and the STE analysis.ResultsWe found similar LVEF between the TBI group and the PER-operative control group (61 % [56–76]) vs. 62 % [52–70]). LV morphological parameters and the systolic function were also similar between the two groups. Regarding the diastolic function, the isovolumic relaxation time was significantly higher in the TBI cohort (125 s [84–178] versus 107 s [83–141], p = 0.04), suggesting a subclinical diastolic dysfunction. Using STE parameters, we observed a trend toward higher strains in the TBI group but only the apical circumferential strain and the basal rotation reached statistical significance. STE-derived parameters of the diastolic function tended to be lower in TBI patients.DiscussionNo systematic myocardial depression was found in a cohort of severe TBI patients.ConclusionsSTE revealed a correct adaptation of the left systolic function, while the diastolic function slightly impaired.Trial registration NCT02380482 Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0323-3) contains supplementary material, which is available to authorized users.

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

“…We used STE, which provides robust and sensitive evaluation of LV function [7,18] and was already studied in SAH patients [8]. Another monocentric pilot study performed in TBI patients also suggested a preserved GLS at baseline [19]. Our data, suggest that stress cardiomyopathy may occur but is not frequent.…”

“…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.…”

Cardiac Dysfunction in Adult Patients with Traumatic Brain Injury: A Prospective Cohort Study

“…Another case-control study of 20 patients with severe TBI also did not find depressed LVEF after a TBI. 5 In a recent prospective study of 32 patients with moderate to severe TBI, the study investigators performed echocardiograms within a day of TBI and followed up with repeat echocardiogram twice after the initial study, over the course of 7-9 days. 4 Seven out of 32 (22%) patients in that study with moderate to severe TBI developed LV systolic dysfunction, and the LV systolic function recovered within one week.…”

“…Incidence of cardiac dysfunction after TBI varied significantly among existing studies, ranging from 0% to 50%. [3][4][5][6]13,14 This discrepancy could be attributed partly to differences in the study design, sample size, heterogeneity in the definition of cardiac dysfunction and differences in the methods of estimating left ventricular systolic function. Two studies from single institution reported that 22% of patients with TBI had evidence of cardiac dysfunction, despite significant differences in the study design, age of the patient population, severity of TBI and echocardiographic methods for estimating LV systolic function (Simpson's method versus fractional shortening).…”

“…4 These findings contradict results from two recent studies that did not find left ventricular systolic dysfunction in a cohort of patients with moderate to severe TBI. 5,6 Due to the paucity of data about the incidence of cardiac dysfunction after a TBI, we decided to conduct a prospective cohort study evaluating the occurrence of cardiac dysfunction after a moderate to severe TBI. We hypothesized that cardiac dysfunction occurs after a TBI and is associated with the severity of brain injury.…”