Prognostic impact of cardiac wall motion abnormalities after TBI: Association with pulmonary complications and cardiovascular comorbidities

Background: Cardiac injury is a well-recognized extracranial complication in patients with acute brain injury, yet limited data exist on its occurrence and clinical implications in traumatic brain injury (TBI). This study aimed to evaluate the incidence, associated risk factors, and outcomes of cardiac wall motion abnormalities (WMA) detected by echocardiography in patients with TBI. Methods: A retrospective observational study was conducted at a regional trauma center in South Korea. Patients admitted with TBI between 2019 and 2023 who underwent transthoracic echocardiography (TTE) were included. Cardiac injury was defined as newly appeared WMA on TTE. Demographics, clinical characteristics, cardiovascular comorbidities, complications, and Glasgow Outcome Scale-Extended (GOSE) scores were analyzed. Comparative analyses between WMA and non-WMA groups were performed using chi-square and t-tests, and univariate/multivariable logistic regression analyses were conducted to identify predictors of post-traumatic WMA and unfavorable outcomes. Results: Among 1,942 TBI patients, 659 underwent TTE, and after excluding preexisting WMA, 641 were analyzed. Of these, 41 patients (6.4%) demonstrated post-traumatic WMA. Patients with WMA had a significantly higher prevalence of cardiovascular comorbidities (75.6% vs. 56.0%, OR = 2.436, p = 0.014) and pulmonary complications (31.7% vs. 18.7%, OR = 2.023, p = 0.041). Severe TBI and major trauma were not significantly associated with WMA. The WMA group had lower mean GOSE scores (3.78 ± 1.90 vs. 4.19 ± 1.86), and a higher proportion of patients with poor outcomes (GOSE 1–2: 31.7% vs. 20.7%). Pulmonary complication was significantly associated with poor outcomes (OR = 2.433, p  < 0.001). Conclusion: Cardiac WMA is not uncommon in TBI patients and may be associated with preexisting cardiovascular disease, increased pulmonary complications, and poor neurological outcomes. Early screening for cardiac injury in high-risk TBI patients may enable tailored treatment strategies and improve clinical outcomes.