Incidence and outcome of cardiac injury in patients with severe head trauma

Ahmed Hasanin, Amr Kamal, Shereen Amin, Dina Zakaria, Riham El Sayed, Kareem Mahmoud, Ahmed Mukhtar, Ahmed Hasanin, Amr Kamal, Shereen Amin, Dina Zakaria, Riham El Sayed, Kareem Mahmoud, Ahmed Mukhtar

Abstract

Background: Although cardiac injury has been reported in patients with various neurological conditions, few data report cardiac injury in patients with traumatic brain injury (TBI). The aim of this work is to report the incidence of cardiac injury in patients with TBI and its impact on patient outcome.

Methods: A prospective observational study was conducted on a cohort of 50 patients with severe TBI. Only patients with isolated severe TBI defined as Glascow coma scale (GCS) < 8 were included in the study. Acute physiology and chronic health evaluation (APACHE) II score, GCS, hemodynamic data, serum Troponin I, electrocardiogram (ECG), and echocardiographic examination, and patients' outcome were recorded. A neurogenic cardiac injury score (NCIS) was calculated for all patients (rising troponin = 1, abnormal echocardiography = 1, hypotension = 1). Univariate and multivariate analyses for risk factors for mortality were done for all risk factors. RESULTS AND DISCUSSION: Fifty patients were included; age was 31 ± 12, APACHE II was 21 ± 5, and male patients were 45 (90 %). Troponin I was elevated in 27 (54 %) patients, abnormal echocardiography and hypotension were documented in 14 (28 %) and 16 (32 %) patients, respectively. The in-hospital mortality was 36 %. Risk factors for mortality by univariate analysis were age, GCS, APACHE II score, serum troponin level, NCIS, and hypotension. However, in multivariate analysis, the only two independent risk factors for mortality were APACHE II score (OR = 1.25, 95 % confidence interval: 1.02-1.54, P = 0.03) and NCIS score (OR = 8.38, 95 % confidence interval: 1.44-48.74, P = 0.018).

Conclusions: Cardiac injury is common in patients with TBI and is associated with increased mortality. The association of high NCIS and poor outcome in these patients warrants a further larger study.

Keywords: Cardiac injury; Echocardiography; Severe head injury; Tsroponin.

Figures

Fig. 1
Fig. 1
Flowchart of patient sampling. ICU: intensive care unit, TBI: traumatic brain injury, GCS: Glasgow coma scale

References

    1. Mayer SA, LiMandri G, Sherman D, et al. Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage. J Neurosurg. 1995;83:889–96. doi: 10.3171/jns.1995.83.5.0889.
    1. Cheung RTF, Hachinski V. Cardiac Effects of Stroke. Curr Treat Options Cardiovasc Med. 2004;6:199–207. doi: 10.1007/s11936-996-0014-x.
    1. Horowitz MB, Willet D, Keffer J. The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 1998;140:87–93. doi: 10.1007/s007010050063.
    1. Bulsara KR, McGirt MJ, Liao L, et al. Use of the peak troponin value to differentiate myocardial infarction from reversible neurogenic left ventricular dysfunction associated with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2003;98:524–8. doi: 10.3171/jns.2003.98.3.0524.
    1. Tung P, Kopelnik A, Banki N, et al. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke. 2004;35:548–52. doi: 10.1161/01.STR.0000114874.96688.54.
    1. Temes RE, Tessitore E, Schmidt JM, et al. Left ventricular dysfunction and cerebral infarction from vasospasm after subarachnoid hemorrhage. Neurocrit Care. 2010;13:359–65. doi: 10.1007/s12028-010-9447-x.
    1. Banki N, Kopelnik A, Tung P, et al. Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage. J Neurosurg. 2006;105:15–20. doi: 10.3171/jns.2006.105.1.15.
    1. Parekh N, Venkatesh B, Cross D, et al. Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol. 2000;36:1328–35. doi: 10.1016/S0735-1097(00)00857-3.
    1. James P, Ellis CJ, Whitlock RM, McNeil AR, Henley J, Anderson NE. Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. BMJ. 2000;320(7248):1502–4. doi: 10.1136/bmj.320.7248.1502.
    1. Di Angelantonio E, Fiorelli M, Toni D, et al. Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry. 2005;76:76–81. doi: 10.1136/jnnp.2004.041491.
    1. Song HS, Back JH, Jin DK, et al. Cardiac troponin T elevation after stroke: Relationships between elevated serum troponin T, stroke location, and prognosis. J Clin Neurol. 2008;4:75–83. doi: 10.3988/jcn.2008.4.2.75.
    1. Stöllberger C, Huber JO, Enzelsberger B, Finsterer J. Fatal outcome of epileptic seizure-induced takotsubo syndrome with left ventricular rupture. Eur J Neurol. 2009;16:e116–7. doi: 10.1111/j.1468-1331.2009.02619.x.
    1. Gelow J, Kruer M, Yadav V, Kaul S. Apical ballooning resulting from limbic encephalitis. Am J Med. 2009;122:583–6. doi: 10.1016/j.amjmed.2008.12.016.
    1. Koepp M, Kern A, Schmidt D. Electrocardiographic changes in patients with brain tumors. Arch Neurol. 1995;52:152–5. doi: 10.1001/archneur.1995.00540260056016.
    1. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352:539–548. doi: 10.1056/NEJMoa043046.
    1. Riera M, Llompart-Pou JA, Carrillo A, Blanco C. Head injury and inverted Takotsubo cardiomyopathy. J Trauma. 2010;68:E13–5. doi: 10.1097/TA.0b013e3181469d5b.
    1. Bahloul BM, Chaari AN, Kallel H, Khabir A, Ayadi A, Charfeddine H, et al. Neurogenic pulmonary edema due to traumatic brain injury: Evidene of cardiac dysfunction. Am J Crit Care. 2006;15:462–470.
    1. Prathep S, Sharma D, Hallman M, et al. Preliminary report on cardiac dysfunction after isolated traumatic brain injury. Crit Care Med. 2014;42:142–7. doi: 10.1097/CCM.0b013e318298a890.
    1. Bergenzaun L, Gudmundsson P, Öhlin H, Düring J, Ersson A, Ihrman L, et al. Assessing left ventricular systolic function in shock : evaluation of echocardiographic parameters in intensive care. Crit Care. 2011;15(4):R200. doi: 10.1186/cc10368.
    1. Chew MS. Haemodynamic monitoring using echocardiography in the critically Ill: A review. Cardiol Res Pract. 2012;2012:139537.
    1. Serri K, El Rayes M, Giraldeau G, Williamson D, Bernard F. Traumatic brain injury is not associated with significant myocardial dysfunction: an observational pilot study. Scand J Trauma Resusc Emerg Med. 2016;24:31. doi: 10.1186/s13049-016-0217-4.
    1. Naredi S, Lambert G, Edén E, et al. Increased sympathetic nervous activity in patients with nontraumatic subarachnoid hemorrhage. Stroke. 2000;31:901–6. doi: 10.1161/01.STR.31.4.901.
    1. Masuda T, Sato K, Yamamoto SI, et al. Sympathetic nervous activity and myocardial damage immediately after subarachnoid hemorrhage in a unique animal model. Stroke. 2002;33:1671–6. doi: 10.1161/01.STR.0000016327.74392.02.
    1. Coghlan LA, Hindman BJ, Bayman EO. Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial. Stroke. 2009;40:412–8. doi: 10.1161/STROKEAHA.108.528778.
    1. Sugimoto K, Watanabe E, Yamada A, et al. Prognostic implications of left ventricular wall motion abnormalities associated with subarachnoid hemorrhage. Int Heart J. 2008;49:75–85. doi: 10.1536/ihj.49.75.
    1. Zaroff JG, Leong J, Kim H, et al. Cardiovascular predictors of long-term outcomes after non-traumatic subarachnoid hemorrhage. Neurocrit Care. 2012;17:374–81. doi: 10.1007/s12028-011-9592-x.
    1. Okabe T, Kanzaria M, Rincon F, Kraft WK. Cardiovascular protection to improve clinical outcomes after subarachnoid hemorrhage: is there a proven role? Neurocrit Care. 2013;18:271–84. doi: 10.1007/s12028-012-9804-z.
    1. Neil-Dwyer G, Walter P, Cruickshank JM, Doshi B, O’Gorman P. Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage. Br Med J. 1978;2(6143):990–2. doi: 10.1136/bmj.2.6143.990.

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