DONOR ISSUES Myocardial Dysfunction Associated with Brain Death: Clinical, Echocardiographic, and Pathologic Features Karl S. Dujardin, MD, a Robert B. McCully, MD, a Eelco F. M. Wijdicks, MD, PhD, b Henry D. Tazelaar, MD, c James B. Seward, MD, a Christopher G. A. McGregor, MD, d and Lyle J. Olson, MD a 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. J Heart Lung Transplant 2001; 20:350–357. From the Division of Cardiovascular Diseases and Internal Medicine, a the Department of Neurology, b the Section of Surgical Pathology, c and the Section of Cardiovascular Sur- gery, d Mayo Clinic and Mayo Foundation, Rochester, Minne- sota Submitted May 30, 2000; accepted July 27, 2000. This study was supported by a fellowship from the Belgian American Educational Foundation (Dr. Dujardin). Reprint requests: Robert B. McCully, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Copyright © 2001 by the International Society for Heart and Lung Transplantation. 1053-2498/01/$–see front matter PII S1053-2498(00)00193-5 350