Abstract
Background: The sequelae of severe brain injury include myocardial dysfunction. 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 with brain death who were evaluated
as heart donors. In a sub-group of patients, we compared echocardiographic findings
with pathologic findings.
Results
Echocardiographic systolic myocardial dysfunction was present in 28 (42%) of 66 patients
and was not predicted by clinical, electrocardiographic, or head computed tomographic
scan characteristics. Ventricular arrhythmias were more common in the patients with,
compared to those without, myocardial dysfunction (32% vs 0%; p < 0.001). Myocardial dysfunction was segmental in all 8 patients with spontaneous
subarachnoid or intracerebral hemorrhage. In these patients, the left ventricular
apex was often spared. Myocardial dysfunction was either segmental or global in 17
patients who suffered head trauma and in 3 patients who died of other central nervous
system illnesses. In 11 autopsied hearts, we found poor correlation between echocardiographic
dysfunction and pathologic findings.
Conclusions
Systolic myocardial dysfunction is common after brain-injury–related brain death.
After spontaneous subarachnoid or intracerebral hemorrhage, the pattern of dysfunction
is segmental, whereas after head trauma, it may be either segmental or global. We
found poor correlation between the echocardiographic distribution of dysfunction and
light microscopic pathologic findings.
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Article info
Publication history
Accepted:
July 27,
2000
Received:
May 30,
2000
Footnotes
☆This study was supported by a fellowship from the Belgian American Educational Foundation (Dr. Dujardin).
Identification
Copyright
© 2001 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
