Myocardial dysfunction associated with brain death: Clinical, echocardiographic, and pathologic features

Background: The sequelae of severe brain injury include myocardial dysfunct ion. We sought to describe the prevalence and characteristics of myocardial dysfunction seen in the context of brain-injury-related brain death and to compare these abnormalities with myocardial pathologic changes. Methods: We examined the clinical course, electrocardiograms, head computed tomography scans, and echocardiographic data of 66 consecutive patients wi th brain death who were evaluated as heart donors. In a sub-group of patien ts, we compared echocardiographic findings with pathologic findings. Results: Echocardiographic systolic myocardial dysfunction was present in 2 8 (42%) of 66 patients and was not predicted by clinical, electrocardiograp hic, or head computed tomographic scan characteristics. Ventricular arrhyth mias were more common in the patients with, compared to those without, myoc ardial dysfunction (33% vs 0%; p < 0.001). Myocardial dysfunction was segme ntal in all 8 patients with spontaneous subarachnoid or intracerebral hemor rhage. In these patients, the left ventricular apes was often spared. Myoca rdial dysfunction was either segmental or global in 17 patients who suffere d head trauma and in 3 patients who died of other central nervous system il lnesses. In 11 autopsied hearts, we found poor correlation between echocard iographic dysfunction and pathologic findings. Conclusions: Systolic myocardial dysfunction is common after brain-injury-r elated brain death. After spontaneous subarachnoid or intracerebral hemorrh age, the pattern of dysfunction is segmental, whereas after head trauma, it may be either segmental or global. We found poor correlation between the e chocardiographic distribution of dysfunction and light microscopic patholog ic findings.