Incidence, Longitudinal Trajectory, and Hemodynamic Implications of Cardiac Dysfunction Following Traumatic Brain Injury

Thesis (Ph.D.)--University of Washington, 2017-06Traumatic brain injury (TBI) is a major public heath problem and leading cause of death and disability worldwide. While hemodynamic instability is common following TBI and associated with increased mortality, few studies have evaluated the function of the heart following TBI. Understanding the role of cardiac dysfunction following TBI represents a major gap in the literature. To address this, the primary aims of the dissertation in isolated moderate-severe TBI patients were: 1) To determine the incidence, longitudinal course, and admission risk factors for systolic dysfunction, 2) To determine the early hemodynamic profile in patients who develop systolic dysfunction, and 3) To examine the association of early myocardial workload and in-hospital mortality. In aim #1, we conducted a prospective cohort study using transthoracic echocardiography (TTE) to determine the incidence of systolic dysfunction within 24 hours following moderate-severe TBI, compared to mild TBI (control group); in addition, we examined the longitudinal course of systolic function over the first week of hospitalization following moderate-severe TBI. In aim #2, we conducted a secondary analysis of the prospective cohort study described in aim #1; we used multivariable linear mixed models to examine the early hemodynamic profile that is associated with the development of systolic dysfunction following moderate-severe TBI. In aim #3, we conducted a retrospective cohort study using the National Trauma Databank (NTDB) to examine the association of the admission rate-pressure product (RRP) with in-hospital mortality following severe TBI. Completion of these aims has helped to uncover a new link between the brain and heart following TBI, and will lead to future studies aiming to personalize hemodynamic management to improve outcomes following TBI