Abdelrahman, A., Abdgalil, W., Taha, A. (2018). Cardiac troponin elevation as an evidence of neurogenic myocardial dysfunction in patients with head trauma. test, 22(3), 95-108. doi: 10.21608/smj.2018.31438
Abdelrahman Hassan Abdelrahman; Wesam Abdgalil; Al haitham Mohamed Taha. "Cardiac troponin elevation as an evidence of neurogenic myocardial dysfunction in patients with head trauma". test, 22, 3, 2018, 95-108. doi: 10.21608/smj.2018.31438
Abdelrahman, A., Abdgalil, W., Taha, A. (2018). 'Cardiac troponin elevation as an evidence of neurogenic myocardial dysfunction in patients with head trauma', test, 22(3), pp. 95-108. doi: 10.21608/smj.2018.31438
Abdelrahman, A., Abdgalil, W., Taha, A. Cardiac troponin elevation as an evidence of neurogenic myocardial dysfunction in patients with head trauma. test, 2018; 22(3): 95-108. doi: 10.21608/smj.2018.31438

Cardiac troponin elevation as an evidence of neurogenic myocardial dysfunction in patients with head trauma

Sohag Medical Journal
Article 12, Volume 22, Issue 3, October 2018, Pages 95-108    PDF (249.63 K)
Document Type: Original Article
DOI: 10.21608/smj.2018.31438
Authors
Abdelrahman Hassan Abdelrahman1; Wesam Abdgalil2; Al haitham Mohamed Taha1
1Department of Anesthesiology, Faculty of Medicine, Sohag University.
2Department of Anesthesiology, Faculty of Medicine, Sohag University
Abstract
Background: cardiac dysfunction is frequently observed after severe traumatic brain injury (sTBI), however its significance is poorly understood. Our study sought to elucidate the association of cardiac troponin I (cTnI) elevation with all cause in-hospital mortality following isolated sTBI (brain AIS ≥ 3 and admission GCS ≤ 8, no AIS ≥3 to any other bodily regions).
Patients and methods: After approval of this study from local ethical committee, and obtaining written informed consent from relatives, head trauma patients will be enrolled in this observational  prospective study. study was conducted in the 10-bed trauma-surgical ICU in Sohag university hospital , Fifty patients with isolated TBI , were consecutively included between January 2015 and February 2017.
Results: our study validated cTnI as a novel biomarker and independent predictor of all cause in-hospital mortality in patients with TBI. these findings have several implications. First, cTnI assay should be considered in patients with sTBI even in absence high suspicion of cardiac injury. Second, cTnI is a sufficiently prognostic biomarker of mortality in patients with sTBI. Third, cTnI elevation in patients with sTBI must be treated with caution.
Conclusion: cTnI level was a significant indicator for stress cardiomyopathy , severity of trauma calculated by RTS had no relation with incidence of stress cardiomyopath . Our study provided important insights to the heart-brain interactions following TBI and possible schemes for subsequent optimization of management of these patients.
Supplementary Files
References
  1.  Babuin L, Jaffe AS. Troponin: the biomarker of choice for detection of cardiac injury. CMAJ. 2005;173:1191–1202.
  2. Roongsritong C, Warraich I, Bradley C. Common causes of troponin elevation in the absence of acute myocardial infarction: incidence and clinical significance. Chest. 2004;125:1877–1884.
  3. Naidech A, Kreiter K, Janjua N, et al. Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation. 2005;112:2851–2856.
  4. Hays A, Diringer MN. Elevated troponin levels are associated with higher mortality following intracerebral hemorrhage. Neurology. 2006;66:1330 –1334.
  5. Zaroff JG, Rordorf GA, Ogilvy CS, et al. Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neurally mediated cardiac injury. J Am Soc Echocardiogr. 2000;13:774 –779.
  6. Schuiling WJ, Dennesen PJ, Tans JT, et al. Troponin I in predicting cardiac or pulmonary complications and outcome in subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2005; 76:1565–1569.
  7. Maramattom BV, Manno EM, Fulgham JR. Clinical importance of cardiac troponin release and cardiac abnormalities in patients with supratentorial cerebral hemorrhages. Mayo Clin Proc. 2006; 81:192–196.
  8. Salim A. Significance of Troponin Elevation After Severe Traumatic Brain Injury. J Trauma. 2008;64:46 –52.
  9. Salim A, Velmahos GC, Jindal A. Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrographicfindings. J Trauma. 2001;50:237–243.
  10. Lippi G, Dipalo M, Carbucicchio A ,et al. The concentration of highly-sensitive troponin I is increased in patients with brain injury after mild head trauma. International Journal of Cardiology. 2013.
  11. Jeremias A, Gibson CM. Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded. Ann Intern Med. 2005;142:786 –791.
  12. Velmahos GC, Karaiskakis M, Salim A. Normal electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. J Trauma. 2003;54:45–51.
  13. Naidech AM, Kreiter KT, Janjua N, Ostapkovich ND, Parra A, Commichau C, Fitzsimmons BF, Connolly ES, Mayer SA. Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation. 2005;112(18):2851–6.
  14. De’Ath HD, Rourke C, Davenport R, Manson J, Renfrew I, Uppal R, Davies LC, Brohi K. Clinical and biomarker profile of trauma-induced secondary cardiac injury. Br J Surg. 2012;99(6):789–97.
  15. Jeremias A, Gibson CM. Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded. Ann Intern Med. 2005;142(9):786–91.
  16. Woolf PD, Hamill RW, Lee LA, Cox C, McDonald JV. The predictive value of catecholamines in assessing outcome in traumatic brain injury. J Neurosurg. 1987;66(6):875–82
  17.  Hamill RW, Woolf PD, McDonald JV, Lee LA, Kelly M. Catecholamines predict outcome in traumatic brain injury. Ann Neurol. 1987;21(5):438–43
  18. Clifton GL, Ziegler MG, Grossman RG. Circulating catecholamines and sympathetic activity after head injury. Neurosurgery. 1981;8(1):10–4
  19. li AS, McCredie VA, Golan E, Shah PS, Nathens AB. Beta blockers for acute traumatic brain injury: a systematic review and meta-analysis. Neurocrit Care. 2014;20(3):514–23
  20. Cotton BA, Snodgrass KB, Fleming SB, Carpenter RO, Kemp CD, Arbogast PG, Morris JA., Jr Beta-blocker exposure is associated with improved survival after severe traumatic brain injury. J Trauma. 2007;62(1):26–33. discussion 33–5.
  21. Grunsfeld A, Fletcher JJ, Nathan BR. Cardiopulmonary complications of brain injury. Curr Neurol Neurosci Rep 2005;5:488-93.
  22. Chadi Dib, MD,a Samuel Asirvatham, MD, FACC,b Ahmed Elesber, MD,c Charanjit Rihal, MD ,FACC ,b Paul Friedman, MD FACC,b and Abhiram Prasad, MD, FRCP, FESC, FACCb Rochester, MN; and Ashland, KY, 2014.
  23. Vijay Krishnamoorthy, Sumidtra Prathep, Deepak Sharma, Edward Gibbons, and Monica S. Vavilala. Association between electrocardiographic findings and cardiac dysfunction in adult isolated traumatic brain injury Indian J Crit care Med. 2014 Sep;18(9):570-574
  24. Ahmed Hasanin1*, Amr Kamal1, Shereen Amin1, Dina Zakaria1, Riham El Sayed2, Kareem Mahmoud3 and Ahmed Mukhtar1, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2016) 24:58
  25. Prathep S, Sharma D, Hallman M, etal. Preliminary report on cardiac duyfunction after isolated traumatic brain injury.Crit Care Med.2014;42:142-7
  26. Serri K, El Rayes M, Giraldeau G, Williamson D, Bernard F. Traumatic braininjury is not associated with significant myocardial dysfunction: anobservational pilot study. Scand J Trauma Resusc Emerg Med. 2016;24:31.
  27. 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(7248):1502–4.
  28. Song HS, Back JH, Jin DK, et al. Cardiac troponin T elevation after stroke: Relationships between elevated serum troponin T, stroke location, and prognosis. J Clin Neurol. 2008;4:75–83.
  29. Coghlan LA, Hindman BJ, Bayman EO. 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.
  30. Zaroff JG, Leong J, Kim H, et al. Cardiovascular predictors of long-term outcomes after non-traumatic subarachnoid hemorrhage. Neurocrit Care. 2012;17:374–81.
  31. Banki N, Kopelnik A, Tung P, et al. Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage. J Neurosurg. 2006;105:15–20.
  32. Marshall, L.F., Eisenberg, H., Jane, J.A. et al. A new classification of head injury based on computed tomography. J Neurosurg. 1991; 75: S14–S20
  33. Maas, A.I., Hukkelhoven, C.W., Marshall, L.F. et al. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. (discussion 1173–1182)Neurosurgery. 2005; 57: 1173–1182
  34. Chun, K.A., Manley, G.T., Stiver, S.I. et al. Interobserver variability in the assessment of CT imaging facture of traumatic brain injury. J Neurotrauma. 2010; 27: 325–330
  35. Katsnelson, M., Mackenzie, L., Frangos, S. et al. Are initial radiology and clinical scales associated with subsequent intracranial pressure and brain oxygen level after severe traumatic brain injury?.Neurosurgery. 2012; 70: 1095–1105
  36. Huang, Y.H., Deng, Y.H., Lee, T.C. et al. Rotterdam computed tomography score as a prognosticator in head-injured patients undergoing decompressive craniectomy. Neurosurgery. 2012; 71: 80–85
  37. Haydel, M.J., Preston, C.A., Mills, T.J. et al. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000; 343: 100–105
  38. Stiell, I.G., Lesiuk, H., Wells, G.A. et al. Canadian CT head rule study for patients with minor head injury: methodology for phase II (validation and economic analysis). Ann Emerg Med. 2001; 38: 317–322
  39. Stocchetti, N., Croci, M., Spagnoli, D. et al. Mass volume measurement in severe head injury: accuracy and feasibility of two pragmatic methods. J Neurol Neurosurg Psychiatry. 2000; 68: 14–17
  40. Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer series in statistics, Springer-Verlag, New York, Inc, 2001
  41. Steyerberg, E.W., Mushkudiani, N., Perel, P. et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristic.PLoS Med. 2008; 5: e165
  42. Lingsma, H.F., Roozenbeek, B., Steyerberg, E.W. et al. Early prognosis in traumatic brain injury: from prophecies to predictions. Lancet Neurol. 2010; 9: 543–554
  43. Jacobs, B., Beems, T., Stulemeijer, M. et al. Outcome prediction in mild traumatic brain injury: age and clinical variables are stronger predictors than CT abnormalities. J Neurotrauma. 2010; 27: 655–668
  44. Gray A, Goyder E, Goodacre S, Johnson G. Trauma triage: a comparison of CRAMS and TRTS in a UK population. Injury 1997; 28: 97−101.
  45. Gilpin D, Nelson P. Revised trauma score: a triage tool in the accident and emergency department. Injury 1991; 22: 35−7.
  46. Luk SS, Jacobs L, Ciraulo D, Cortes V, Sable A, Dowell VL. Outcome assessment of physiologic and clinical predictors of survival in patients after traumatic injury with a trauma score less than 5. J. Trauma 1999; 46: 122−7.
  47.  Kilaru S, Garb JL, Emhoff TA et al. Long‐term functional status and mortality of elderly patients with severe closed head injuries. J. Trauma 1996; 41: 957−63
  48. Kuhls DA, Malone DL, McCarter RJ, Napolitano LM. Predictors of mortality in adult trauma patients. The physiologic trauma score is equivalent to the trauma and injury severity score. J. Am. Coll. Surg. 2002; 194: 695−704.
  49.  Moini M, Rezaishiraz H, Zafarghandi MR. Characteristics and outcome of injured patients treated in urban trauma centers in Iran. J. Trauma 2000; 48: 503−7.
  50. Brennan PW, Everest ER, Griggs WM et al. Risk of death among cases attending South Australian major trauma services after severe trauma: the first 4 years of operation of a state trauma system. J. Trauma 2002; 53: 333−9
  51.  Zafonte R, Hammond F, Mann N, Wood D, Millis S, Black K. Revised trauma score: an additive predictor of disability following traumatic brain injury? Am. J. Phys. Med. Rehabil. 1996; 75: 456−61.
  52.  Wagner AK, Hammond FM, Sasser HC, Wiercisiewski D, Norton HJ. Use of injury severity variables in determining disability and community integration after traumatic brain injury. Trauma J.2000; 49: 411−19
  53. Hafiz NA. Evaluation of revised Trauma Score in poly-traumatized patients. Journal of College of Physicians and Surgeons Pakistan. 2004;14(5):286–289
  54. Ohaegbulam SC, Okafor UV. Using the Revised Trauma Score to Predict Outcome in Severely Head Injured Patients in a Developing Nation-A Pilot Study. Journal of College of Medicine. 2007;12(2):51–55
  55. Riera M, Llompart-Pou JA, Carrillo A, Blanco C. Head injury and inverted Takotsubo cardiomyopathy. J Trauma. 2010;68:E13–5.
  56. Bahloul BM, Chaari AN, Kallel H, Khabir A, Ayadi A, Charfeddine H, et al. Neurogenic pulmonary edema due to traumatic brain injury: Evidene of cardiac dysfunction. Am J Crit Care. 2006;15:462–70.
  57. Okabe T, Kanzaria M, Rincon F, Kraft WK. Cardiovascular protection to improve clinical outcomes after subarachnoid hemorrhage: is there a proven role? Neurocrit Care. 2013;18:271–84.
  58. Neil-Dwyer G, Walter P, Cruickshank JM, Doshi B, O’Gorman P. Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage. Br Med J. 1978;2(6143):990–2.

 

 

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