Top

Published in:

01-01-2017 | Original Scientific Report

The Role of Troponin in Blunt Cardiac Injury After Multiple Trauma in Humans

Authors: Miriam Kalbitz, Jochen Pressmar, Johanna Stecher, Birte Weber, Manfred Weiss, Stephan Schwarz, Erich Miltner, Florian Gebhard, Markus Huber-Lang

Published in: World Journal of Surgery | Issue 1/2017

Abstract

Background

The incidence of cardiac injury in immediate fatalities after blunt trauma remains underestimated, and reliable diagnostic strategies are still missing. Furthermore, clinical data concerning heart-specific troponin serum levels, injury severity score (ISS), catecholamine treatment and survival of patients on admission to the hospital have rarely been interrelated so far. Therefore, the object of the present study was to identify predictive parameters for mortality in the context of blunt cardiac injury.

Methods

This retrospective observational study included 173 severely injured patients with an ISS ≥25 admitted to the University Hospital of Ulm, a level 1 trauma center, during 2009–2013 . Furthermore, 83 blunt trauma victims who died before hospital admission were subjected to postmortem examination at the Institute of Legal Medicine, University of Ulm, during 2009–2014. ISS, cardiac injury and associated thoracic injuries were determined in both groups. Furthermore, in the hospitalized patients, serum troponin and IL-6 levels were measured.

Results

Macroscopic heart injury was observed in 18 % of the patients who died at the scene and only in 1 % of the patients admitted to the hospital, indicating that macroscopic heart injury is associated with an immediate life-threatening condition. Troponin levels were elevated in 43 % of the patients after admission to the hospital. Moreover, troponin serum concentrations were significantly higher in patients treated with norepinephrine (26.4 ± 4 ng/l) and in non-survivors (84.9 ± 22.8 ng/l) compared to patients without catecholamines and survivors, respectively.

Conclusions

Macroscopic heart injury was 20 times more frequent in non-survivors than in survivors. Serum troponin levels correlated with mortality after multiple injury and therefore may represent a valuable prognostic marker in trauma patients.

Available only for authorised users

Sybrandy KC, Cramer MJM, Burgersdijk C (2003) Diagnosing cardiac contusion: old wisdom and new insights. Heart 89(5):485–489CrossRefPubMedPubMedCentral

Elie MC (2006) Blunt cardiac injury. Mt Sinai J Med 73(2):542–552PubMed

Huber S, Biberthaler P, Delhey P, Trentzsch H, Winter H, van Griensven M, Lefering R, Huber-Wagner S, and DGU TR. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU (R)). Scandinavian Journal of Trauma Resuscitation & Emergency Medicine. 2014;22:52

Skinner DL, Laing GL, Rodseth RN, Ryan L, Hardcastle TC, Muckart DJ (2015) Blunt cardiac injury in critically ill trauma patients: a single centre experience. Injury. 46(1):66–70CrossRefPubMed

Theodoropoulos I, Cheeyandira A, Tortella BJ (2013) Traumatic Tricuspid Valve Rupture Presenting as Third-Degree Atrioventricular Block. J Emerg Med 45(2):175–177CrossRefPubMed

Kusumoto A, Miyata M, Kubozono T, Ikeda Y, Shinsato T, Kuwahata S, Fujita S, Takasaki K, Yuasa T, Hamasaki S et al (2012) Highly sensitive cardiac troponin T in heart failure: comparison with echocardiographic parameters and natriuretic peptides. J Cardiol 59(2):202–208CrossRefPubMed

Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–196CrossRefPubMed

Wisner DH, Reed WH, Riddick RS (1990) Suspected myocardial contusion. Triage and indications for monitoring. Ann Surg 212(1):82–86CrossRefPubMedPubMedCentral

Huang YK, Lu MS, Liu KS, Liu EH, Chu JJ, Tsai FC, Lin PJ (2010) Traumatic pericardial effusion: impact of diagnostic and surgical approaches. Resuscitation. 81(12):1682–1686CrossRefPubMed

10.

Ritchie D, Trott T, Bryant J, Stearley S, Adkins B (2013) Takutsubo Cardiomyopathy and Flash Pulmonary Edema in a Trauma Patient. J Emerg Med 45(4):530–532CrossRefPubMed

11.

Odell DD, Peleg K, Givon A, Radomislensky I, Makey I, Decamp MM, Whyte R, Gangadharan SP, Berger RL, and Israeli Trauma G. Sternal fracture: isolated lesion versus polytrauma from associated extrasternal injuries–analysis of 1,867 cases. J Trauma Acute Care Surg. 2013;75(3):448-52

12.

Dua A, McMaster J, Desai PJ, Desai SS, Kuy S, Mata M, and Cooper J. The Association between Blunt Cardiac Injury and Isolated Sternal Fracture. Cardiol Res Pract. 2014;2014(629687

13.

Rashid MA, Ortenwall P, Wikstrom T (2001) Cardiovascular injuries associated with sternal fractures. Eur J Surg 167(4):243–248CrossRefPubMed

14.

Mirvis SE (2005) Imaging of acute thoracic injury: the advent of MDCT screening. Semin Ultrasound CT MR 26(5):305–331CrossRefPubMed

15.

Paone RF, Peacock JB, Smith DLT (1993) Diagnosis of Myocardial Contusion. South Med J 86(8):867–870CrossRefPubMed

16.

Hanschen M, Kanz KG, Kirchhoff C, Khalil PN, Wierer M, van Griensven M, Laugwitz KL, Biberthaler P, Lefering R, Huber-Wagner S et al (2015) Blunt Cardiac Injury in the Severely Injured - A Retrospective Multicentre Study. PLoS ONE 10(7):e0131362CrossRefPubMedPubMedCentral

17.

Moore EE, Malangoni MA, Cogbill TH, Shackford SR, Champion HR, Jurkovich GJ, McAninch JW, Trafton PG (1994) Organ injury scaling. IV: thoracic vascular, lung, cardiac, and diaphragm. J Trauma 36(3):299–300CrossRefPubMed

18.

Bertinchant JP, Robert E, Polge A, de la Coussaye JE, Pignodel C, Aya G, Fabbro-Peray P, Poirey S, Ledermann B, Eledjam JJ et al (1999) Release kinetics of cardiac troponin I and cardiac troponin T in effluents from isolated perfused rabbit hearts after graded experimental myocardial contusion. J Trauma 47(3):474–480CrossRefPubMed

19.

Collins JN, Cole FJ, Weireter LJ, Riblet JL, and Britt LD. The usefulness of serum troponin levels in evaluating cardiac injury. Am Surg. 2001;67(9):821-5; discussion 5-6

20.

Bertinchant JP, Polge A, Mohty D, Nguyen-Ngoc-Lam R, Estorc J, Cohendy R, Joubert P, Poupard P, Fabbro-Peray P, Monpeyroux F et al (2000) Evaluation of incidence, clinical significance, and prognostic value of circulating cardiac troponin I and T elevation in hemodynamically stable patients with suspected myocardial contusion after blunt chest trauma. Journal of Trauma-Injury Infection and Critical Care. 48(5):924–931CrossRef

21.

Rajan GP, Zellweger R (2004) Cardiac troponin I as a predictor of arrhythmia and ventricular dysfunction in trauma patients with myocardial contusion. Journal of Trauma-Injury Infection and Critical Care. 57(4):801–808CrossRef

22.

Agewall S, Giannitsis E, Jernberg T, Katus H (2011) Troponin elevation in coronary vs. non-coronary disease. Eur Heart J 32(4):404–411CrossRefPubMed

23.

Karu I, Tahepold P, Sulling TA, Alver M, Zilmer M, Starkopf J (2009) Off-pump coronary surgery causes immediate release of myocardial damage markers. Asian Cardiovasc Thorac Ann. 17(5):494–499CrossRefPubMed

24.

Wan S, DeSmet JM, Barvais L, Goldstein M, Vincent JL, LeClerc JL (1996) Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 112(3):806–811CrossRefPubMed

25.

Boland TA, Lee VH, Bleck TP (2015) Stress-induced cardiomyopathy. Crit Care Med 43(3):686–693CrossRefPubMed

26.

Pfortmueller CA, Lindner G, Leichtle AB, Fiedler GM, Exadaktylos AK (2014) Diagnostic significance of high sensitivity troponin in diagnosis of blunt cardiac injury. Intensive Care Med 40(4):623–624CrossRefPubMed

Title: The Role of Troponin in Blunt Cardiac Injury After Multiple Trauma in Humans
Authors: Miriam Kalbitz
Jochen Pressmar
Johanna Stecher
Birte Weber
Manfred Weiss
Stephan Schwarz
Erich Miltner
Florian Gebhard
Markus Huber-Lang
Publication date: 01-01-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 1/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3650-7

ACC 2024 Congress

Springer Medicine

The Role of Troponin in Blunt Cardiac Injury After Multiple Trauma in Humans

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Is the Reluctance for the Implantation of Right Kidneys Justified: Reply

Breast Conservative Therapy for Multifocal–Multicentric Breast Cancers

The Addition of Dexmedetomidine to Analgesia for Patients After Abdominal Operations: A Prospective Randomized Clinical Trial

Discontinuity of the Bowel Following Damage Control Operation Revisited: A Multi-institutional Study

Quality of Life and Medico-Legal Implications Following Iatrogenic Bile Duct Injuries

Effectiveness and Mechanism of Preoperative Lugol Solution for Reducing Thyroid Blood Flow in Patients with Euthyroid Graves’ Disease: Reply