Myocardial function at the early phase of traumatic brain injury: a prospective controlled studyReport as inadecuate




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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

, 24:129

First Online: 28 October 2016Received: 11 July 2016Accepted: 23 October 2016

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 registrationNCT02380482

Abbreviations2D2-dimensional

CVPCentral venous pressure

GLSGlobal longitudinal strain

ICUIntensive care unit

IVRTIsovolumetric relaxation time

LALeft atrial

LVLeft ventricle

LVEFLeft ventricular ejection fraction

MACMinimal alveolar concentration

MAPMean arterial pressure

RVRight ventricle

SAHSubarachnoid haemorrhage

STESpeckle tracking echocardiography

SVRISystemic vascular resistance index

TAPSETricuspid annular plane systolic excursion

TBITraumatic brain injury

TCDBTraumatic coma data bank

Electronic supplementary materialThe online version of this article doi:10.1186-s13049-016-0323-3 contains supplementary material, which is available to authorized users.

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Author: Adrien Cuisinier - Claire Maufrais - Jean-François Payen - Stephane Nottin - Guillaume Walther - Pierre Bouzat

Source: https://link.springer.com/







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