Myocardial Dysfunction at Early Phase of Traumatic Brain Injury : Evaluation by Two Dimensional and Speckle Tracking Transthoracic Echocardiography

Study Overview
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Brief Summary
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Traumatic brain injury (TBI) is a frequent pathology leading to major morbidity and mortality in young people. Cerebral flood flow maintenance is a major goal directed therapy to improve the prognosis of the patient. Due to cerebral-myocardial interaction, a myocardial dysfunction might occur at the early phase of the traumatic brain injury. This myocardial dysfunction could be partly responsible for a decrease in cerebral blood flow. In such case, improving myocardial dysfunction may help to increase cerebral blood flow and improve patient prognosis. In clinical practice the easiest and non invasive way to explore myocardial dysfunction is with transthoracic echocardiography. The objective of this trial is to investigate myocardial dysfunction at the early phase of traumatic brain injury, compared with a controlled group without TBI.

Official Title
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Myocardial Dysfunction at Early Phase of Traumatic Brain Injury : Evaluation by Two Dimensional and Speckle Tracking Transthoracic Echocardiography

Conditions
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Traumatic Brain Injury

Intervention / Treatment
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* Other: Transthoracic echocardiography on TBI patients
* Other: Transthoracic echocardiography on control patients


Participation Criteria
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Eligibility Criteria
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TBI patients Inclusion Criteria: Isolated and non opened traumatic brain injury 18 - 65 years old Intubated and mechanically ventilated Glasgow score < or = 9 or Glasgow score between 9 and 13 (included) and Following Traumatic Coma Data Bank Tomographic Damages diffuse injuries type III or IV or mass lesion over 25ml and/or neurosurgical injuries Medical insurance Exclusion Criteria: Treated major cardiovascular risks factors cardiovascular past medical history (acute cardiovascular event) Cardio thoracic surgery Brain dead status Inotrope drugs Severe polytraumatism Acute haemorrhage Non echogenic patient High level athlete Incapacitated person by law and pregnant women Discovery during echocardiography of underlying cardiomyopathy Urgent neurosurgery required Control patients Inclusion Criteria: Isolated and non opened traumatic brain injury 18 - 65 years old Intubated and mechanically ventilated Paired with TBI patient on age, BMI and sex Undergoing urgent non severe surgery Medical insurance Exclusion Criteria: Traumatic brain injury Treated major cardiovascular risks factors cardiovascular past medical history (acute cardiovascular event) Cardio thoracic surgery Inotrope and vasopressive drugs Circulatory failure Non echogenic patient High level athlete Incapacitated person by law and pregnant women Discovery during echocardiography of underlying cardiomyopathy Urgent neurosurgery required

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Traumatic brain injury<br>Two dimensional and speckle tracking transthoracic echocardiography in traumatic brain injured patients Glasgow score < or = 9 or Glasgow score between 9 and 13 (included) and Following Traumatic Coma Data Bank Tomographic Damages: diffuse injuries type III or IV or mass lesion over 25ml and/or neurosurgical injuries | Other: Transthoracic echocardiography on TBI patients<br>* Two Dimensional and speckle trackingTransthoracic echocardiography on TBI patients within 24 hours of trauma<br>|
| Other: Controls<br>Two dimensional and speckle tracking transthoracic echocardiography in control patients paired with traumatic brain injured patient on age, BMI and sex with the following criteria: Intubated and mechanically ventilated Undergoing urgent non severe surgery | Other: Transthoracic echocardiography on control patients<br>* Two Dimensional and speckle trackingTransthoracic echocardiography on control patients while intubated-ventilated<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| left ventricular ejection fraction |  | within the first 24 hours after injury | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Strain evaluation by speckle tracking (in percentage of systolic duration) |  | within the first 24 hours after injury | 
| Systolic strain rate by speckle tracking (in second) |  | within the first 24 hours after injury | 
| Diastolic strain rate by speckle tracking (in second) |  | within the first 24 hours after injury | 
| Systolic rotational velocity by speckle tracking (in degree by second) |  | within the first 24 hours after injury | 
| Diastolic rotational velocity by speckle tracking (in degree by second) |  | within the first 24 hours after injury | 
| Systolic twisting velocity by speckle tracking (in degree by second) |  | within the first 24 hours after injury | 
| Diastolic untwisting velocity by speckle tracking (in degree by second) |  | within the first 24 hours after injury | 
| Myocardial wall thickness (in millimeter) | 2D transthoracic echography | within the first 24 hours after injury | 
| left ventricular diastolic function (cm/sec) | 2D transthoracic echography | within the first 24 hours after injury | 
| Cardiac index | 2D transthoracic echography | within the first 24 hours after injury | 
| tissue doppler imaging (cm/sec) | 2D transthoracic echography | within the first 24 hours after injury | 
| right ventricular diastolic function | 2D transthoracic echography | within the first 24 hours after injury | 
| right ventricular systolic function | 2D transthoracic echography | within the first 24 hours after injury | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Traumatic brain injury, Myocardial dysfunction, Transthoracic echocardiography, Speckle tracking