Chaikittisilpa Nophanan, Kiatchai Taniga, Liu Sunny Yang, Kelly-Hedrick Margot, Vavilala Monica S, Lele Abhijit V, Komisarow Jordan, Ohnuma Tetsu, Colton Katharine, Krishnamoorthy Vijay
Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
J Neurosurg Anesthesiol. 2023 Nov 20. doi: 10.1097/ANA.0000000000000945.
Myocardial injury and cardiac dysfunction after traumatic brain injury (TBI) have been reported in observational studies, but there is no robust estimate of their incidences. We conducted a systematic review and meta-analysis to estimate the pooled incidence of myocardial injury and cardiac dysfunction among adult patients with TBI. A literature search was conducted using MEDLINE and EMBASE databases from inception to November 2022. Observational studies were included if they reported at least one abnormal electrocardiographic finding, elevated cardiac troponin level, or echocardiographic evaluation of systolic function or left ventricular wall motion in adult patients with TBI. Myocardial injury was defined as elevated cardiac troponin level according to the original studies and cardiac dysfunction was defined as the presence of left ventricular ejection fraction <50% or regional wall motion abnormalities assessed by echocardiography. The meta-analysis of the pooled incidence of myocardial injury and cardiac dysfunction was performed using random-effect models. The pooled estimated incidence of myocardial injury after TBI (17 studies, 3,773 participants) was 33% (95% CI: 27%-39%, I2:s 93%), and the pooled estimated incidence of cardiac dysfunction after TBI (9 studies, 557 participants) was 16.% (95% CI: 9%-25.%, I2: 84%). Although there was significant heterogeneity between studies and potential overestimation of the incidence of myocardial injury and cardiac dysfunction, our findings suggest that myocardial injury occurs in approximately one-third of adults after TBI, and cardiac dysfunction occurs in approximately one-sixth of patients with TBI.
观察性研究已报道创伤性脑损伤（TBI）后存在心肌损伤和心脏功能障碍，但对其发生率尚无可靠估计。我们进行了一项系统评价和荟萃分析，以估计成年TBI患者中心肌损伤和心脏功能障碍的合并发生率。使用MEDLINE和EMBASE数据库从创建到2022年11月进行文献检索。纳入的观察性研究需报告成年TBI患者至少一项异常心电图结果、心脏肌钙蛋白水平升高或收缩功能或左心室壁运动的超声心动图评估。根据原始研究，心肌损伤定义为心脏肌钙蛋白水平升高，心脏功能障碍定义为左心室射血分数<50%或经超声心动图评估存在节段性室壁运动异常。使用随机效应模型对心肌损伤和心脏功能障碍的合并发生率进行荟萃分析。TBI后心肌损伤的合并估计发生率（17项研究，3773名参与者）为33%（95%CI：27%-39%，I²：93%），TBI后心脏功能障碍的合并估计发生率（9项研究，557名参与者）为16.%（95%CI：9%-25.%，I²：84%）。尽管研究之间存在显著异质性，且心肌损伤和心脏功能障碍的发生率可能被高估，但我们的研究结果表明，约三分之一的成年TBI患者会发生心肌损伤，约六分之一的TBI患者会发生心脏功能障碍。
