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. 2017 Jun;45(6):1028-1036.
doi: 10.1097/CCM.0000000000002404.

Early Systolic Dysfunction Following Traumatic Brain Injury: A Cohort Study

Vijay Krishnamoorthy  1 , Ali Rowhani-Rahbar, Edward F Gibbons, Frederick P Rivara, Nancy R Temkin, Crystal Pontius, Kevin Luk, Morgan Graves, Danielle Lozier, Nophanan Chaikittisilpa, Taniga Kiatchai, Monica S Vavilala
Affiliations

Early Systolic Dysfunction Following Traumatic Brain Injury: A Cohort Study

Vijay Krishnamoorthy et al. Crit Care Med. 2017 Jun.

Abstract

Objective: Prior studies have suggested that traumatic brain injury may affect cardiac function. Our study aims were to determine the frequency, longitudinal course, and admission risk factors for systolic dysfunction in patients with moderate-severe traumatic brain injury.

Design: Prospective cohort study.

Setting: Level 1 trauma center.

Measurements: Transthoracic echocardiogram within 1 day and over the first week after moderate-severe traumatic brain injury; transthoracic echocardiogram within 1 day after mild traumatic brain injury (comparison group).

Measurements and main results: Systolic function was assessed by transthoracic echocardiogram, and systolic dysfunction was defined as fractional shortening less than 25%. Multivariable Poisson regression models examined admission risk factors for systolic dysfunction. Systolic function in 32 patients with isolated moderate-severe traumatic brain injury and 32 patients with isolated mild traumatic brain injury (comparison group) was assessed with transthoracic echocardiogram. Seven (22%) moderate-severe traumatic brain injury and 0 (0%) mild traumatic brain injury patients had systolic dysfunction within the first day after injury (p < 0.01). All patients with early systolic dysfunction recovered in 1 week. Younger age (relative risk, 0.87; 95% CI, 0.79-0.94; for 1 yr increase in age) and lower admission Glasgow Coma Scale score (relative risk, 0.34; 95% CI, 0.20-0.58; for one unit increase in Glasgow Coma Scale) were independently associated with the development of systolic dysfunction among moderate-severe traumatic brain injury patients.

Conclusions: Early systolic dysfunction can occur in previously healthy patients with moderate-severe traumatic brain injury, and it is reversible over the first week of hospitalization. Younger age and lower admission Glasgow Coma Scale score are independently associated with the development of systolic dysfunction after moderate-severe traumatic brain injury.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1
Figure 1. Change in Fractional Shortening Over the First Week of Hospitalization in Patients with Moderate-Severe Traumatic Brain Injury and Initial Systolic Dysfunction a,b
aIn above boxplots, solid line represents median value, box represents interquartile range, and whiskers represent adjacent values bEchocardiograms at approximately 3 days and 1 week after injury were performed in the majority to patients, although some exams are missing secondary to clinical procedures, patient death, or patient discharge from the hospital
See this image and copyright information in PMC

Comment in

  • Cardiac Function Following Traumatic Brain Injury.
    Longhi L, Ferri F, Cavalleri G, Lorini L. Longhi L, et al. Crit Care Med. 2017 Nov;45(11):e1193-e1194. doi: 10.1097/CCM.0000000000002616. Crit Care Med. 2017. PMID: 29028719 No abstract available.
  • The authors reply.
    Krishnamoorthy V, Rowhani-Rahbar A, Gibbons EF, Rivara FP, Temkin NR, Chaikittisilpa N, Luk K, Vavilala MS. Krishnamoorthy V, et al. Crit Care Med. 2017 Nov;45(11):e1194-e1195. doi: 10.1097/CCM.0000000000002663. Crit Care Med. 2017. PMID: 29028720 Free PMC article. No abstract available.
  • Systolic Dysfunction Following Traumatic Brain Injury.
    Venkata C. Venkata C. Crit Care Med. 2018 Feb;46(2):e183. doi: 10.1097/CCM.0000000000002812. Crit Care Med. 2018. PMID: 29337821 No abstract available.
  • The authors reply.
    Krishnamoorthy V, Rowhani-Rahbar A, Gibbons EF, Chaikittisilpa N, Vavilala MS. Krishnamoorthy V, et al. Crit Care Med. 2018 Feb;46(2):e183-e184. doi: 10.1097/CCM.0000000000002865. Crit Care Med. 2018. PMID: 29337822 Free PMC article. No abstract available.

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