Early myocardial damage (EMD) and valvular insufficiency result in impaired cardiac function after multiple trauma in pigs

Abstract

One third of multiple trauma patients present abnormal echocardiographic (ECHO) findings. Therefore, ECHO diagnostic after trauma is indicated in case of hemodynamic instability, shock, after chest trauma and after cardiac arrest. 20 male pigs underwent multiple trauma. Blood samples were collected 4 and 6 h after trauma and concentrations of heart-type fatty acid binding protein (HFABP) as a biomarker for EMD were measured. Myocardial damage was evaluated by scoring Hematoxylin–Eosin stained sections. At baseline, 3 and 6 h after trauma, transesophageal ECHO (TOE) was performed, invasive arterial and left ventricular blood pressure were measured to evaluate the cardiac function after multiple trauma. Systemic HFABP concentrations were elevated, furthermore heart injury score in multiple trauma animals was increased determining EMD. A significant decrease of blood pressure in combination with a consecutive rise of heart frequency was observed. Ongoing depression of mean arterial pressure and diastolic blood pressure were accompanied by changes in ECHO-parameters indicating diastolic and systolic dysfunction. Furthermore, a valvular dysfunction was detected. In this study complex myocardial and valvular impairment after multiple trauma in pigs has been observed. Therefore, detection of EMD and progressive valvular dysfunction might be crucial and therapeutically relevant.

Why are bleeding trauma patients still dying? Towards a systems hypothesis of trauma

“…It has been estimated that around 30% of polytrauma patients have abnormal ventricular wall motion abnormalities and troponin 1 release with concomitant falls in stroke volume (SV) and cardiac output (CO), despite inotrope and vasopressor support ( Wall et al, 2019 ; Weber et al, 2021 ). In addition, aggressive fluid replacement, particularly in hypovolemic patients, can further increase the risk of adverse cardiac events and mortality ( Wall et al, 2019 ; Weber et al, 2021 ).…”

“…It has been estimated that around 30% of polytrauma patients have abnormal ventricular wall motion abnormalities and troponin 1 release with concomitant falls in stroke volume (SV) and cardiac output (CO), despite inotrope and vasopressor support ( Wall et al, 2019 ; Weber et al, 2021 ). In addition, aggressive fluid replacement, particularly in hypovolemic patients, can further increase the risk of adverse cardiac events and mortality ( Wall et al, 2019 ; Weber et al, 2021 ). Although smaller resuscitation fluid volumes are recommended (200–500 ml), some patients respond to the fluid challenge with increased SV and CO, while others do not, indicating preload is only one factor in rebalancing cardiac performance ( Marik and Lemson, 2014 ; Ueyama and Kiyonaka, 2017 ).…”

“…Shifting autonomic balance from sympathetic 'hyperdrive' towards parasympathetic dominance would rebalance the system to reduce immune dysregulation and inflammation and improve end-organ functions (Tracey, 2009;Huston and Tracey, 2011;Lombardi and Stein, 2011;Reyes del Paso et al, 2013;Olshansky, 2016;Sykora et al, 2016;Johansson et al, 2017a;Letson et al, 2022). It has been estimated that around 30% of polytrauma patients have abnormal ventricular wall motion abnormalities and troponin 1 release with concomitant falls in stroke volume (SV) and cardiac output (CO), despite inotrope and vasopressor support (Wall et al, 2019;Weber et al, 2021). In addition, aggressive fluid replacement, particularly in hypovolemic patients, can further increase the risk of adverse cardiac events and mortality (Wall et al, 2019;Weber et al, 2021).…”

Recent Developments in Mouse Trauma Research Models: A Mini-Review

“…Cardiovascular dysfunction is characterized by lower cardiac output and stroke volume (Wall et al, 2019), dysrhythmias including ventricular fibrillation, cardiac arrest, and wall motion disorders as well as ongoing hypotension (B. Weber et al, 2021a;B. Weber et al, 2021b).…”