The National Institutes of Health’s National Institute of Neurological Disorders and Stroke (NINDS) has awarded Duke Anesthesiology’s Vijay Krishnamoorthy, MD, PhD, a $944,405, five-year K23 grant for his project, titled “Mechanisms and Clinical Impact of Myocardial Injury Following Traumatic Brain Injury.”
Traumatic brain injury (TBI) is a major public health concern, affecting more than 1.7 million individuals annually in the United States. Hypotension after severe TBI results in cerebral hypoperfusion and poor clinical outcomes. Approximately 50 percent of severe TBI patients are treated for hypotension and maintenance of cerebral perfusion, possibly due to unrecognized myocardial injury and cardiac dysfunction.
Krishnamoorthy’s prior research has demonstrated that 22 percent of patients with moderate-severe TBI have early cardiac dysfunction, patients with TBI and cardiac dysfunction exhibit signs of sympathetic activation, and patients with TBI and cardiac dysfunction experience unstable hemodynamics. Sympathetic activation is implicated in cardiac dysfunction and hypotension after TBI, but mechanistic data is limited.
The central hypothesis of Krishnamoorthy’s new study is that severe TBI causes myocardial injury through activation of the sympathetic nervous system, resulting in systolic cardiac dysfunction, reduced cardiac output, hypotension, decreased cerebral perfusion, and poor neurologic outcomes. Results of this study are expected to lead to a larger trial that examines the impact of reduction of sympathetic nervous system activation on myocardial injury and neurologic outcomes after severe TBI.
“I anticipate that the results of this study will help us gain a fundamental understanding of the role of the sympathetic nervous system in causing myocardial injury following TBI,” says Krishnamoorthy. “In addition, I hope that this study will help to open up the era of personalized hemodynamic management in severe TBI.”