Vijay Krishnamoorthy1,2, Nophanan Chaikittisilpa2, James Lee3, G Burkhard Mackensen4, Edward F Gibbons5,2, Daniel Laskowitz6, Adrian Hernandez7, Eric Velazquez8, Abhijit V Lele4, Monica S Vavilala4,2. 1. Department of Anesthesiology. 2. Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA. 3. Department of Internal Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI. 4. Departments of Anesthesiology & Pain Medicine. 5. Cardiology. 6. Department of Neurology. 7. Department of Internal Medicine, Division of Cardiology, Duke University, Durham, NC. 8. Department of Internal Medicine, Division of Cardiology, Yale University, New Haven, CT.
Abstract
BACKGROUND: Systolic dysfunction and reduction in left ventricular ejection fraction (LVEF) has been documented after traumatic brain injury (TBI). Speckle tracking is an emerging technology for myocardial strain assessment which has been utilized to identify subclinical myocardial dysfunction, and is most commonly reported as global longitudinal strain (GLS). We examined myocardial strain and regional strain patterns following moderate-severe TBI. MATERIALS AND METHODS: We conducted a prospective cohort study of moderate-severe TBI patients (Glasgow Coma Scale≤12) and age/sex-matched controls. Transthoracic echocardiography was performed within the first day and 1 week following TBI. Myocardial function was assessed using both GLS and LVEF, and impaired systolic function was defined as GLS >-16% or LVEF ≤50%. Regional strain patterns and individual strain trajectories were examined. RESULTS: Thirty subjects were included, 15 patients with TBI and 15 age/sex-matched controls. Among patients with adequate echocardiographic windows, systolic dysfunction was observed in 2 (17%) patients using LVEF and 5 (38%) patients using GLS within the first day after TBI. Mean GLS was impaired in patients with TBI compared with controls (-16.4±3.8% vs. -20.7±1.8%, P=0.001). Regional myocardial examination revealed impaired strain primarily in the basal and mid-ventricular segments. There was no improvement in GLS from day 1 to day 7 (P=0.81). CONCLUSIONS: Myocardial strain abnormalities are common and persist for at least 1 week following moderate-severe TBI. Speckle tracking may be useful for the early diagnosis and monitoring of systolic dysfunction following TBI.
BACKGROUND: Systolic dysfunction and reduction in left ventricular ejection fraction (LVEF) has been documented after traumatic brain injury (TBI). Speckle tracking is an emerging technology for myocardial strain assessment which has been utilized to identify subclinical myocardial dysfunction, and is most commonly reported as global longitudinal strain (GLS). We examined myocardial strain and regional strain patterns following moderate-severe TBI. MATERIALS AND METHODS: We conducted a prospective cohort study of moderate-severe TBI patients (Glasgow Coma Scale≤12) and age/sex-matched controls. Transthoracic echocardiography was performed within the first day and 1 week following TBI. Myocardial function was assessed using both GLS and LVEF, and impaired systolic function was defined as GLS >-16% or LVEF ≤50%. Regional strain patterns and individual strain trajectories were examined. RESULTS: Thirty subjects were included, 15 patients with TBI and 15 age/sex-matched controls. Among patients with adequate echocardiographic windows, systolic dysfunction was observed in 2 (17%) patients using LVEF and 5 (38%) patients using GLS within the first day after TBI. Mean GLS was impaired in patients with TBI compared with controls (-16.4±3.8% vs. -20.7±1.8%, P=0.001). Regional myocardial examination revealed impaired strain primarily in the basal and mid-ventricular segments. There was no improvement in GLS from day 1 to day 7 (P=0.81). CONCLUSIONS: Myocardial strain abnormalities are common and persist for at least 1 week following moderate-severe TBI. Speckle tracking may be useful for the early diagnosis and monitoring of systolic dysfunction following TBI.
Authors: Vijay Krishnamoorthy; Ali Rowhani-Rahbar; Edward F Gibbons; Frederick P Rivara; Nancy R Temkin; Crystal Pontius; Kevin Luk; Morgan Graves; Danielle Lozier; Nophanan Chaikittisilpa; Taniga Kiatchai; Monica S Vavilala Journal: Crit Care Med Date: 2017-06 Impact factor: 7.598
Authors: Christian Templin; Jelena R Ghadri; Johanna Diekmann; L Christian Napp; Dana R Bataiosu; Milosz Jaguszewski; Victoria L Cammann; Annahita Sarcon; Verena Geyer; Catharina A Neumann; Burkhardt Seifert; Jens Hellermann; Moritz Schwyzer; Katharina Eisenhardt; Josef Jenewein; Jennifer Franke; Hugo A Katus; Christof Burgdorf; Heribert Schunkert; Christian Moeller; Holger Thiele; Johann Bauersachs; Carsten Tschöpe; Heinz-Peter Schultheiss; Charles A Laney; Lawrence Rajan; Guido Michels; Roman Pfister; Christian Ukena; Michael Böhm; Raimund Erbel; Alessandro Cuneo; Karl-Heinz Kuck; Claudius Jacobshagen; Gerd Hasenfuss; Mahir Karakas; Wolfgang Koenig; Wolfgang Rottbauer; Samir M Said; Ruediger C Braun-Dullaeus; Florim Cuculi; Adrian Banning; Thomas A Fischer; Tuija Vasankari; K E Juhani Airaksinen; Marcin Fijalkowski; Andrzej Rynkiewicz; Maciej Pawlak; Grzegorz Opolski; Rafal Dworakowski; Philip MacCarthy; Christoph Kaiser; Stefan Osswald; Leonarda Galiuto; Filippo Crea; Wolfgang Dichtl; Wolfgang M Franz; Klaus Empen; Stephan B Felix; Clément Delmas; Olivier Lairez; Paul Erne; Jeroen J Bax; Ian Ford; Frank Ruschitzka; Abhiram Prasad; Thomas F Lüscher Journal: N Engl J Med Date: 2015-09-03 Impact factor: 91.245
Authors: Alexander R Lyon; Sian E Harding; Helen Paur; Peter T Wright; Markus B Sikkel; Matthew H Tranter; Catherine Mansfield; Peter O'Gara; Daniel J Stuckey; Viacheslav O Nikolaev; Ivan Diakonov; Laura Pannell; Haibin Gong; Hong Sun; Nicholas S Peters; Mario Petrou; Zhaolun Zheng; Julia Gorelik Journal: Circulation Date: 2012-06-25 Impact factor: 29.690
Authors: Ahmed Hasanin; Amr Kamal; Shereen Amin; Dina Zakaria; Riham El Sayed; Kareem Mahmoud; Ahmed Mukhtar Journal: Scand J Trauma Resusc Emerg Med Date: 2016-04-27 Impact factor: 2.953