Relationships between Elevated Plasma Cardiac Troponin I and Cardiac Dysfunction in Patients with Severe Brain Damage
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Objective: The aims of the present study were to clarify the clinical significance of elevated plasma cardiac troponin I (cTnI) in patients with severe brain damage and to investigate whether the measurement of plasma cTnI is useful for evaluating cardiac function in those patients. Subjects and Methods: The study population comprised patients with traumatic brain injury who scored 8 or less on the Glasgow Coma Scale (GCS) on admission (TBI group; N=6) and those with intracranial hemorrhage due to cerebrovascular disease (ICH/SAH group; N=12). Procedures at admission included the recording or determination of the patient genders, ages, vital signs, ECGs, PaO2/FiO2 (P/F) ratios, SIRS, and APACHE II scores. CTnI and CK-MB were measured over time. The upper limit of the normal cTnI level in this study was defined as 0.1ng/ml. There were 4 and 7 deaths in the TBI and ICH/SAH groups, respectively. Results: Fifteen out of 18 (83.3%) patients had peak cTnI>0.1ng/ml. Of the 18 patients, 14 (77.8%) showed a cTnI value of 0.1ng/ml or less at 72 hours after a transient increase (peak cTnI). ST-T changes were observed in the ECGs of 8 patients, but the peak cTnI level did not correlate with age, mean blood pressure, heart rates, APACHE II scores, or GCS on admission. On the other hand, 12 (66.7%) of 18 patients had a P/F ratio<300. Chest x-rays and plain chest CT scans revealed lung edema/gravity-dependent consolidation (L/G) in 7 patients. Cardiac echography revealed a decreased ejection fraction in 3 of 9 patients examined. Four patients (66.7%) in the TBI group and 9 patients (75.0%) in the ICH/SAH group were diagnosed with SIRS on admission. The peak cTnI (p<0.05) was significantly higher in the patients with increased SIRS scores. Discussion and Conclusion: Unlike the cTnI elevation typically seen in myocardial infarction, that observed in our patients with severe brain damage was transient. Moreover, few incidences of the cardiac dysfunction were revealed in the brain damage patients with elevated cTnI. Our results suggest that the evaluation of cardiac dysfunction based on cTnI measurement might be of less clinical significance after severe brain damage. Further, the correlation noted between elevated cTnI and the SIRS score on admission suggested that the systemic inflammatory responses at the onset of brain damage might be involved in the cTnI elevation.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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