P.045 Reversible Left Ventricular Dysfunction and Brain Natriuretic Peptide (BNP) Plasma Levels in Patients with Traumatic Brain Injury

Abstract

Aim

We investigated the possibility of myocardial dysfunction and pertinent alterations of BNP plasma levels in patients with traumatic brain injury (TBI).

Patients and Methods

This study included 30 critically care patients (20 males, mean age 30 ± 8 years old) who were admitted to the intensive care unit with TBI (Glasgow Coma Scale upon admission<8). Patients with a previous history of cardiovascular disease, chest trauma, sepsis and/or other critical illness known to be associated with myocardial dysfunction were excluded. Left ventricular (LV) function was assessed by transoesophageal echocardiography. BNP plasma concentrations were measured in all patients. Echocardiographic and BNP measurements were performed on a weekly basis.

Results

Eight patients progressed towards brain death. Five patients presented global reversible LV dysfunction during the first week after the TBI, which normalized over time (within 2 weeks upon presentation). Ten patients exhibited segmental contractility disturbances during the first 2 weeks after the TBI, which normalized over time (within 4 weeks upon presentation). All the above patients presented electrocardiogram changes that normalized in line with the echocardiographic changes. The initial BNP plasma concentrations in the 15 patients with the reversible cardiovascular dysfunction were significantly increased as compared with those without cardiovascular dysfunction (105 ±53 pg/ml vs. 53 ± 26 pg/ml, p<0.001). BNP concentrations were positively correlated with diffuse subarachnoid hemorrhage (r = 0.85, p<0.001) and poor outcome (r = 0.88, p<0.001).

Conclusion

Reversible cardiac disturbances developed in almost 50% of patients with TBI. Increased BNP concentrations are associated with a poor outcome in the above patients.