Cardiac Dysfunction in Blunt Traumatic Brain Injury Patients

IMPORTANCE: 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). OBJECTIVES: We assessed cardiac dysfunction after blunt TBI by echocardiographic signatures, association with intracranial abnormalities, and clinical findings. DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMES AND MEASURES: 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. RESULTS: 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. CONCLUSIONS AND RELEVANCE: 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.