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Early Systolic Dysfunction Following Traumatic Brain Injury: A Cohort Study

Krishnamoorthy, Vijay MD, MPH1–3; Rowhani-Rahbar, Ali MD, MPH, PhD2,3; Gibbons, Edward F. MD3,4; Rivara, Frederick P. MD, MPH2,3,5; Temkin, Nancy R. PhD3,6,7; Pontius, Crystal RDCS4; Luk, Kevin MD, MS1; Graves, Morgan BS3,8; Lozier, Danielle BS3; Chaikittisilpa, Nophanan MD3; Kiatchai, Taniga MD3; Vavilala, Monica S. MD1,3

doi: 10.1097/CCM.0000000000002404
Neurologic Critical Care

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.

1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.

2Department of Epidemiology, University of Washington, Seattle, WA.

3Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA.

4Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA.

5Department of Pediatrics, University of Washington, Seattle, WA.

6Department of Neurosurgery, University of Washington, Seattle, WA.

7Department of Biostatistics, University of Washington, Seattle, WA.

8Georgetown University School of Medicine, Washington, DC.

Supported, in part, by grants from National Institutes of Health—National Research Service Award (T32 GM086270) and Washington State Society of Anesthesiologists Seafair Research Grant.

Dr. Krishnamoorthy’s institution received funding from the National Institutes of Health (NIH) and Washington State Society of Anesthesiologists, and he received support for article research from the NIH. Dr. Temkin’s institution received funding from multiple grant and applications to different U.S. federal sources, and she received funding from consulting for Data and Safety Monitoring Boards and Statistical Consulting (unrelated to article topic). Mr. Graves received support for article research from the NIH and Foundation for Anesthesia Education and Research. Dr. Vavilala received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: vkrish@u.washington.edu

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