Cardiac Dysfunction in Blunt Traumatic Brain Injury Patients

Cardiac dysfunction following blunt traumatic brain injury (TBI) has been commonly defined as new decreased ejection fraction (EF) or new regional wall motion abnormalities (RWMAs).

We assessed cardiac dysfunction after blunt TBI by echocardiographic signatures, association with intracranial abnormalities, and clinical findings.

Retrospective cohort study of adult blunt TBI patients hospitalized at an American College of Surgeons verified Level 1 Trauma Center during 2022-2023 who underwent echocardiography (echo) within 48 hours of admission. Patients with preexisting cardiac comorbidities were excluded.

The trauma registry at a Level 1 Trauma Center and corresponding electronic medical record were reviewed for TBI patients. Echo reports were evaluated for cardiac dysfunction as measured by EF, RWMAs, and fractional shortening (FS). FS is a simple M-mode measure predictive of systolic function defined as the percentage change in left ventricular diameter between the end of diastole and systole.

Of 105 blunt TBI patients meeting inclusion criteria, 81 had normal FS, 23 patients had decreased FS below 30%, and 1 had increased FS on echo. All 81 patients with normal FS had preserved EF, but 19 of 23 (83%) patients with decreased FS also had preserved EF. Patients with decreased FS had increased ICU length of stay, inpatient mortality, and craniotomy/craniectomy rates. Subarachnoid hemorrhage was the most frequent intracranial abnormality in patients with decreased FS.

FS was depressed in a subset of TBI patients with above adverse in-hospital outcomes. Our data suggest FS below 30% may be a useful echocardiographic parameter associated with clinically significant cardiac dysfunction in blunt TBI patients.