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Myocardial dysfunction associated with brain death: clinical, echocardiographic, and pathologic features
K S Dujardin1, R B McCully, E F Wijdicks
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Summary
Systolic myocardial dysfunction is common in brain death patients, affecting 42%. The pattern varies: segmental after hemorrhage, and segmental or global after head trauma. Echocardiography and pathology correlations were poor.
Area of Science:
- Neurology
- Cardiology
- Pathology
Background:
- Severe brain injury can lead to myocardial dysfunction.
- Brain death following brain injury presents a unique context for studying cardiac abnormalities.
- Understanding myocardial dysfunction in brain death is crucial for donor management and patient care.
Purpose of the Study:
- To determine the prevalence and characteristics of myocardial dysfunction in brain death.
- To compare echocardiographic findings with pathological changes in the myocardium.
- To identify predictors of myocardial dysfunction in brain-injured patients.
Main Methods:
- Echocardiographic, clinical, electrocardiographic, and head CT data were analyzed for 66 brain death patients.
- A subgroup underwent comparison of echocardiographic and pathological findings.
- Patients were evaluated as potential heart donors.
Main Results:
- Systolic myocardial dysfunction was observed in 42% of patients (28/66).
- Ventricular arrhythmias were significantly more common in patients with myocardial dysfunction (32% vs. 0%).
- Dysfunction patterns differed: segmental in hemorrhage (apex often spared), segmental or global in head trauma.
Conclusions:
- Systolic myocardial dysfunction is a frequent complication of brain death.
- The pattern of myocardial dysfunction is associated with the cause of brain injury (hemorrhage vs. trauma).
- Echocardiographic assessment of dysfunction showed limited correlation with light microscopic pathology.