Key result
Lower subendocardial viability ratio is linked to increased mortality in severe traumatic brain injury.
Why the study?
Traumatic brain injury is often associated with cardiac dysfunction due to brain–heart cross talk, but changes in subendocardial viability ratio in severe TBI patients without prior cardiac disease are not well characterized.
Observational (n=64)
Severe traumatic brain injury is associated with decreased subendocardial viability ratio, which is lower in non-survivors and improves following surgical decompression, highlighting brain-heart cross talk.
Answers are grounded in this paper and cite their sources.
May signal myocardial perfusion changes in severe TBI; leaves open clinical utility pending prospective validation.
Background: Traumatic brain injury (TBI) is often associated with cardiac dysfunction, which is a consequence of the brain–heart cross talk. The subendocardial viability ratio (SEVR) is an estimate of myocardial perfusion. The aim of this study was to analyze changes in the SEVR in patients with severe TBI without previous cardiac diseases. Methods: Adult patients treated for severe TBI with a Glasgow coma score <8 were studied. Pressure waveforms were obtained by a high-fidelity tonometer in the radial artery for SEVR calculation at five time points: immediately after admission to the intensive care unit and 24, 48, 72, and 96 h after admission. SEVRs and other clinically important parameters were analyzed in patients who survived and did not survive after 28 days of treatment, as well as in patients who underwent decompressive craniectomy (DC). Results: A total of 64 patients (16 females and 48 males) aged 18–64 years were included. Fifty patients survived and 14 died. DC was performed in 23 patients. SEVRs decreased 24 h after admission in nonsurvivors ( p < 0.05) and after 48 h in survivors ( p < 0.01) and its values were significantly lower in nonsurvivors than in survivors at 24, 72, and 96 h from admission ( p < 0.05). The SEVR increased following DC ( p < 0.05). Conclusions: A decreased SEVR is observed in TBI patients. Surgical decompression increases the SEVR, indicating improvement in coronary microvascular perfusion. The results of our study seem to confirm that brain injury affects myocardium function.
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Siwicka-Gieroba et al. (2021) conducted an observational in Severe Traumatic Brain Injury (TBI) (n=64). Severe traumatic brain injury vs. Survivors vs Nonsurvivors was evaluated on Subendocardial viability ratio (SEVR) changes over 96 hours (p=< 0.05). In patients with severe traumatic brain injury, the subendocardial viability ratio was significantly lower in nonsurvivors than in survivors at 24, 72, and 96 hours from admission (p<0.05).
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