Key result
Moderate-severe TBI is linked to ~22% higher incidence of early reversible systolic dysfunction vs mild TBI.
Why the study?
Prior studies suggested traumatic brain injury may affect cardiac function, but the frequency, course, and risk factors for systolic dysfunction were unclear.
Does moderate-severe traumatic brain injury increase the risk of early systolic dysfunction compared to mild traumatic brain injury?
Cohort (n=64)
No
Does moderate-severe traumatic brain injury increase the risk of early systolic dysfunction compared to mild traumatic brain injury?
Absolute Event Rate: 22% vs 0%
p-value: p=<0.01
Early, reversible systolic dysfunction occurs in a significant proportion of patients following moderate-severe traumatic brain injury, particularly in younger patients with lower Glasgow Coma Scale scores.
Suggests early cardiac screening may be warranted in moderate-severe TBI; leaves open whether this.
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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Krishnamoorthy et al. (2017) conducted a cohort in Traumatic Brain Injury (n=64). Moderate-severe traumatic brain injury vs. Mild traumatic brain injury was evaluated on Systolic dysfunction (fractional shortening < 25%) within the first day after injury (p=<0.01). Moderate-severe traumatic brain injury was associated with early systolic dysfunction compared to mild traumatic brain injury (22% vs 0%; P<0.01), which was fully reversible within 1 week.
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