Diagnostic approach for myocardial contusion: a retrospective evaluation of patient data and review of the literature

Abstract

Purpose Myocardial contusion can be a life-threatening condition in patients who sustained blunt thoracic trauma. The diagnostic approach remains a subject of debate. The aim of this study was to determine the sensitivity and specificity of echocardiography, electrocardiography, troponins T and I (TnT and TnI), and creatine kinase muscle/brain (CK-MB) for identifying patients with a myocardial contusion following blunt thoracic trauma. Methods Sensitivity and specificity were first determined in a 10-year retrospective cohort study and second by a systematic literature review with meta-analysis. Results Of the 117 patients in the retrospective study, 44 (38%) were considered positive for myocardial contusion. Chest X-ray, chest CT scan, electrocardiograph, and echocardiography had poor sensitivity (< 15%) but good specificity (≥ 90%). Sensitivity to cardiac biomarkers measured at presentation ranged from 59% for TnT to 77% for hs-TnT, specificity ranged from 63% for CK-MB to 100% for TnT. The systematic literature review yielded 28 studies, with 14.5% out of 7242 patients reported as positive for myocardial contusion. The pooled sensitivity of electrocardiography, troponin I, and CK-MB was between 62 and 71%, versus only 45% for echocardiography and 38% for troponin T. The pooled specificity ranged from 63% for CK-MB to 85% for troponin T and 88% for echocardiography. Conclusion The best diagnostic approach for myocardial contusion is a combination of electrocardiography and measurement of cardiac biomarkers. If abnormalities are found, telemonitoring is necessary for the early detection of life-threatening arrhythmias. Chest X-ray and CT scan may show other thoracic injuries but provide no information on myocardial contusion.

Blunt Cardiac Injury in Patients With Sternal Fractures

“…We agree with the opinion that no single test could serve as a gold standard for myocardial contusion [ 17 , 25 ]. The questions of what constitutes BCI, what tests are the most accurate for BCI diagnosis, or what combination of tests is the best for certain cohorts of blunt thoracic trauma patients, remain in discussion.…”

“…We agree with the opinion that no single test could serve as a gold standard for myocardial contusion [17,25]. Conceivably, the definition of BCI could also include the timing of an optimal diagnostic window, as a very early ENZ test may show normal values, and similarly the results of a very late ECH can be inviolate since BCI symptoms may already be resolved with time and/or medication.…”

“…Certain BCI studies even exclude patients with pre-existing cardiac comorbidities (CC) [ 6 , 9 ]. Furthermore, discussions continue regarding the guidelines for diagnostic testing, including the sequence and combination of necessary tests to substantiate the BCI diagnosis [ 17 ]. Overall there is a scarcity of studies addressing BCI in patients with different types of SF, as well as in cohorts of patients with pre-existing cardiac conditions [ 14 , 18 ].…”

Traumatic tricuspid regurgitation following equine related blunt chest trauma and review of the literature

“…The exact incidence of myocardial contusion in patients with blunt chest trauma is difficult to estimate as diagnostic criteria vary between institutions, but has been reported between 10% and 70%. 2 Myocardial contusion may predispose a patient to hypotension and arrhythmia. Arrhythmia typically occurs between 24 and 48 h after the injury.…”

“…Infrequently, the blunt chest trauma leads to myocardial contusion. The exact incidence of myocardial contusion in patients with blunt chest trauma is difficult to estimate as diagnostic criteria vary between institutions, but has been reported between 10% and 70% 2 . Myocardial contusion may predispose a patient to hypotension and arrhythmia.…”