Wojciech Dabrowski1, Todd T Schlegel2, Jaroslaw Wosko3, Radoslaw Rola4, Ziemowit Rzecki3, Manu L N G Malbrain5, Andrzej Jaroszynski6. 1. Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland. Electronic address: w.dabrowski5@yahoo.com. 2. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden and Nicollier-Schlegel SARL, Trélex, Switzerland. 3. Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Poland. 4. Department of Neurosurgery and Paediatric Neurosurgery, Medical University of Lublin, Poland. 5. Intensive Care Unit and High Care Burn Unit, Ziekenhuis Netwerk Antwerp, ZNA Stuivenberg, Antwerp, Belgium; Intensive Care Unit, University Hospital Brussels (UZB), Jette, Belgium; Faculty of Medicine, Free University of Brussels (VUB), Brussels, Belgium. 6. Department of Nephrology, Institute of Medical Science, Jan Kochanowski University of Kielce, Poland.
Abstract
Introduction: Traumatic brain injury (TBI) affects cardiac electrical function, and several extra-cerebral factors, including intra-abdominal pressure (IAP), might further modulate this brain-heart interaction. The purpose of this study was to investigate the impact of TBI, and of increased IAP during TBI, on cardiac electrical function as measured by vectorcardiographic (VCG) variables. Methods: Survival, IAP and changes in VCG variables including spatial QRS-T angle and QTc interval were measured in consecutive adult patients with either isolated TBI (iTBI), or with TBI accompanied by polytrauma to the abdomen and/or limbs (pTBI). For all patients, observations were performed just after the admission to the ICU (baseline) and at 24, 48, 72 and 96 h after admission. Results: 74 patients aged 45 ± 18 were studied. 44 were treated for iTBI and 30 for pTBI. In all patients, spatial QRS-T angle and QTc interval increased after TBI (p < 0.001), relatively more so in patients with pTBI. Compared to survivors, non-survivors also ultimately had greater widening of the spatial QRS-T angle (p < 0.001), most notably just before foraminal herniation. Wider spatial QRS-T angle and longer QTc interval were also noted in patients with IAP > 12 mmHg (p < 0.001), and with right compared to left hemispheric injury (p < 0.001). ST segment level at the J point decreased 24 and 48 h after TBI in leads I, II, III, aVR, aVF, V1, V2, V3 and V6, and increased in lead V1, especially in non-survivors. Conclusions: Spatial QRS-T angle and QTc interval increase after TBI. If foraminal herniation complicates TBI, further widening of the spatial QRS-T angle typically precedes it, followed by notable narrowing thereafter. Increased IAP also intensifies TBI-associated increases in spatial QRS-T angle and QTc interval.
Introduction: Traumatic brain injury (TBI) affects cardiac electrical function, and several extra-cerebral factors, including intra-abdominal pressure (IAP), might further modulate this brain-heart interaction. The purpose of this study was to investigate the impact of TBI, and of increased IAP during TBI, on cardiac electrical function as measured by vectorcardiographic (VCG) variables. Methods: Survival, IAP and changes in VCG variables including spatial QRS-T angle and QTc interval were measured in consecutive adult patients with either isolated TBI (iTBI), or with TBI accompanied by polytrauma to the abdomen and/or limbs (pTBI). For all patients, observations were performed just after the admission to the ICU (baseline) and at 24, 48, 72 and 96 h after admission. Results: 74 patients aged 45 ± 18 were studied. 44 were treated for iTBI and 30 for pTBI. In all patients, spatial QRS-T angle and QTc interval increased after TBI (p < 0.001), relatively more so in patients with pTBI. Compared to survivors, non-survivors also ultimately had greater widening of the spatial QRS-T angle (p < 0.001), most notably just before foraminal herniation. Wider spatial QRS-T angle and longer QTc interval were also noted in patients with IAP > 12 mmHg (p < 0.001), and with right compared to left hemispheric injury (p < 0.001). ST segment level at the J point decreased 24 and 48 h after TBI in leads I, II, III, aVR, aVF, V1, V2, V3 and V6, and increased in lead V1, especially in non-survivors. Conclusions: Spatial QRS-T angle and QTc interval increase after TBI. If foraminal herniation complicates TBI, further widening of the spatial QRS-T angle typically precedes it, followed by notable narrowing thereafter. Increased IAP also intensifies TBI-associated increases in spatial QRS-T angle and QTc interval.
Entities:
Keywords:
Brain-heart interaction; Intra-abdominal pressure; ST segment; Vectorcardiography
Authors: Wojciech Dabrowski; Dorota Siwicka-Gieroba; Chiara Robba; Rafael Badenes; Katarzyna Kotfis; Todd T Schlegel; Andrzej Jaroszynski Journal: Int J Environ Res Public Health Date: 2020-11-21 Impact factor: 3.390