Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 18 , ISSUE 9 ( September, 2014 ) > List of Articles

RESEARCH ARTICLE

Association between electrocardiographic findings and cardiac dysfunction in adult isolated traumatic brain injury

Vijay Krishnamoorthy, Sumidtra Prathep, Edward Gibbons, Monica S. Vavilala

Keywords : Cardiac function, electrocardiography, traumatic brain injury

Citation Information : Krishnamoorthy V, Prathep S, Gibbons E, Vavilala MS. Association between electrocardiographic findings and cardiac dysfunction in adult isolated traumatic brain injury. Indian J Crit Care Med 2014; 18 (9):570-574.

DOI: 10.4103/0972-5229.140144

License: CC BY-ND 3.0

Published Online: 01-10-2007

Copyright Statement:  Copyright © 2014; The Author(s).


Abstract

Introduction: Abnormal electrocardiographic (ECG) findings can be seen in traumatic brain injury (TBI) patients. ECG may be an inexpensive tool to identify patients at high risk for developing cardiac dysfunction after TBI. The aim of this study was to examine abnormal ECG findings after isolated TBI and their association with true cardiac dysfunction, based on echocardiogram. Methods: Data from adult patients with isolated TBI between 2003 and 2010 was retrospectively examined. Inclusion criteria included the presence of a 12-lead ECG within 24 h of admission and a formal echocardiographic examination within 72 h of admission after TBI. Patients with preexisting cardiac disease were excluded. Baseline clinical characteristics, 12-lead ECG, and echocardiogram report were abstracted. Logistic regression was used to identify the relationship of specific ECG abnormalities with cardiac dysfunction. Results: We examined data from 59 patients with isolated TBI who underwent 12-lead ECG and echocardiographic evaluation. In this cohort, 13 (22%) patients had tachycardia (heart rate >100 bpm), 25 (42.4%) patients had a prolonged QTc, and 6 (10.2%) patients had morphologic end-repolarization abnormalities (MERA), with each having an association with abnormal echocardiographic findings: Odds ratios (and 95% confidence intervals) were 4.14 (1.02-17.05), 9.0 (1.74-46.65), and 5.63 (1.96-32.94), respectively. Ischemic-like ECG changes were not associated with echocardiographic abnormalities. Conclusions: Repolarization abnormalities (prolonged QTc and MERA), but not ischemic-like ECG changes, are associated with cardiac dysfunction after isolated TBI. 12-lead ECG may be an inexpensive screening tool to evaluate isolated TBI patients for cardiac dysfunction prior to more expensive or invasive studies.

PDF Share
  1. Rutland-Brown W, Langlois JA, Thomas KE, Xi YL. Incidence of traumatic brain injury in the United States, 2003. J Head Trauma Rehabil 2006;21:544-8.
  2. Jeremitsky E, Omert L, Dunham CM, Protetch J, Rodriguez A. Harbingers of poor outcome the day after severe brain injury: Hypothermia, hypoxia, and hypoperfusion. J Trauma 2003;54:312-9.
  3. Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993;34:216-22.
  4. Zafar SN, Millham FH, Chang Y, Fikry K, Alam HB, King DR, et al. Presenting blood pressure in traumatic brain injury: A bimodal distribution of death. J Trauma 2011;71:1179-84.
  5. Pietropaoli JA, Rogers FB, Shackford SR, Wald SL, Schmoker JD, Zhuang J. The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries. J Trauma 1992;33:403-7.
  6. Sharma D, Brown MJ, Curry P, Noda S, Chesnut RM, Vavilala MS. Prevalence and risk factors for intraoperative hypotension during craniotomy for traumatic brain injury. J Neurosurg Anesthesiol 2012;24:178-84.
  7. Samuels MA. The brain-heart connection. Circulation 2007;116:77-84.
  8. Grunsfeld A, Fletcher JJ, Nathan BR. Cardiopulmonary complications of brain injury. Curr Neurol Neurosci Rep 2005;5:488-93.
  9. Fan X, Du FH, Tian JP. The electrocardiographic changes in acute brain injury patients. Chin Med J (Engl) 2012;125:3430-3.
  10. Junttila E, Vaara M, Koskenkari J, Ohtonen P, Karttunen A, Raatikainen P, et al. Repolarization abnormalities in patients with subarachnoid and intracerebral hemorrhage: Predisposing factors and association with outcome. Anesth Analg 2013;116:190-7.
  11. Lowensohn RI, Weiss M, Hon EH. Heart-rate variability in brain-damaged adults. Lancet 1977;1:626-8.
  12. Baguley IJ, Heriseanu RE, Felmingham KL, Cameron ID. Dysautonomia and heart rate variability following severe traumatic brain injury. Brain Inj 2006;20:437-44.
  13. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352:539-48.
  14. Kono T, Morita H, Kuroiwa T, Onaka H, Takatsuka H, Fujiwara A. Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: Neurogenic stunned myocardium. J Am Coll Cardiol 1994;24:636-40.
  15. Hinson HE, Sheth KN. Manifestations of the hyperadrenergic state after acute brain injury. Curr Opin Crit Care 2012;18:139-45.
  16. Zygun DA, Kortbeek JB, Fick GH, Laupland KB, Doig CJ. Non-neurologic organ dysfunction in severe traumatic brain injury. Crit Care Med 2005;33:654-60.
  17. Coghlan LA, Hindman BJ, Bayman EO, Banki NM, Gelb AW, Todd MM, et al. Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: Findings from the intraoperative hypothermia aneurysm surgery trial. Stroke 2009;40:412-8.
  18. Collier BR, Miller SL, Kramer GS, Balon JA, Gonzalez LS 3rd. Traumatic subarachnoid hemorrhage and QTc prolongation. J Neurosurg Anesthesiol 2004;16:196-200.
  19. Hravnak M, Frangiskakis JM, Crago EA, Chang Y, Tanabe M, Gorcsan J 3rd, et al. Elevated cardiac troponin I and relationship to persistence of electrocardiographic and echocardiographic abnormalities after aneurysmal subarachnoid hemorrhage. Stroke 2009;40:3478-84.
  20. James P, Ellis CJ, Whitlock RM, McNeil AR, Henley J, Anderson NE. Relation between troponin T concentration and mortality in patients presenting with an acute stroke: Observational study. BMJ 2000;320:1502-4.
  21. Ako J, Sudhir K, Farouque HM, Honda Y, Fitzgerald PJ. Transient left ventricular dysfunction under severe stress: Brain-heart relationship revisited. Am J Med 2006;119:10-7.
  22. Mashaly HA, Provencio JJ. Inflammation as a link between brain injury and heart damage: The model of subarachnoid hemorrhage. Cleve Clin J Med 2008;75 Suppl 2:S26-30.
  23. Davison DL, Terek M, Chawla LS. Neurogenic pulmonary edema. Crit Care 2012;16:212.
  24. Richard C. Stress-related cardiomyopathies. Ann Intensive Care 2011;1:39.
  25. Berman M, Ali A, Ashley E, Freed D, Clarke K, Tsui S, et al. Is stress cardiomyopathy the underlying cause of ventricular dysfunction associated with brain death? J Heart Lung Transplant 2010;29:957-65.
  26. Sookplung P, Siriussawakul A, Malakouti A, Sharma D, Wang J, Souter MJ, et al. Vasopressor use and effect on blood pressure after severe adult traumatic brain injury. Neurocrit Care 2011;15:46-54.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.