Prognostic Value of Cardiac Troponin I and T on Admission in Mortality of Multiple Trauma Patients Admitted to the Emergency Department: a Prospective Follow-up Study

Montazer, Seyed Hossein; Jahanian, Fatemeh; Khatir, Iraj Goli; Bozorgi, Farzad; Assadi, Touraj; Pashaei, Seyedeh Masoumeh; Sazgar, Mohammad; Mousavi, Seyed Jaber; Yekta, Abbas Setayesh

doi:10.5455/medarh.2019.73.11-14

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…In our unresuscitated model, we identified cardiac functional changes and myocardial damage with comparable elevations in the cardiomyocyte damage molecule H-FABP (21) to those reported in clinical studies (8, 22). The associated functional decreases in cardiac output were at least in part related to the loss of stroke volume.…”

Section: Discussionsupporting

confidence: 67%

Modeling Cardiac Dysfunction Following Traumatic Hemorrhage Injury: Impact on Myocardial Integrity

et al. 2019

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Cardiac dysfunction (CD) importantly contributes to mortality in trauma patients, who survive their initial injuries following successful hemostatic resuscitation. This poor outcome has been correlated with elevated biomarkers of myocardial injury, but the pathophysiology triggering this CD remains unknown. We investigated the pathophysiology of acute CD after trauma using a mouse model of trauma hemorrhage shock (THS)-induced CD with echocardiographic guidance of fluid resuscitation, to assess the THS impact on myocardial integrity and function. Mice were subjected to trauma (soft tissue and bone fracture) and different degrees of hemorrhage severity (pressure controlled ~MABP < 35 mmHg or <65 mmHg) for 1 h, to characterize the acute impact on cardiac function. In a second study, mice were subjected to trauma and hemorrhage (MABP < 35 mmHg) for 1 h, then underwent two echocardiographic-guided resuscitations to baseline stroke volume at 60 and 120 min, and were monitored up to 180 min to study the longer impact of THS following resuscitation. Naïve and sham animals were used as controls. At 60 min post-THS injury, animals showed a lower cardiac output (CO) and stroke volume (SV) and an early rise of heart fatty acid-binding protein (H-FABP = 167 ± 38 ng/ml; 90% increase from shams, 3.54 ± 3.06 ng/ml), when subjected to severe hemorrhage and injury. Despite resuscitation, these animals maintained lower CO (6 ml/min vs. 23 ml/min), lower SV (10 μl vs. 46 μl; both ~75% decreased), and higher H-FABP (levels (340 ± 115 ng/ml vs. 10.3 ± 0.2 ng/ml; all THS vs. shams, P < 0.001) at 180 min post-THS injury. Histopathological and flow-cytometry analysis of the heart confirmed an influx of circulatory leukocytes, compared to non-injured hearts. Myocardial injury was supported by an increase of troponin I and h-FABP and the widespread ultrastructural disorganization of the morphology of sarcomeres and mitochondria. DNA fragmentation and chromatin condensation driven by leakage of apoptosis-inducing factor (AIF) may suggest a mitochondria-driven progressive cell death. THS modeling in the mouse results in cardiomyocyte damage and reduced myocardial function, which mimics the cardiac dysfunction seen in trauma patients. This CD model may, therefore, provide further understanding to the mechanisms underlying CD and act as a tool for developing cardioprotective therapeutics to improve survival after injury.

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Section: Discussionsupporting

confidence: 67%

Modeling Cardiac Dysfunction Following Traumatic Hemorrhage Injury: Impact on Myocardial Integrity

et al. 2019

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“…In addition, their study showed a strong association between thoracic trauma severity and cTnI release [ 47 ]. Similarly, a recent study in Iran concluded that elevated cardiac troponin I and T levels provide excellent prognostic information regarding mortality in patients with multiple trauma, independent of age, hemodynamic variables, and Glasgow Coma Scale (GCS) score [ 48 ]. In contrast, Edouard et al concluded that cTnI could not be used as a prognostic factor in trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Management of Thoracic and Cardiac Trauma: A Case Series and Literature Review

Kumar¹,

Shiwalkar²,

Bhate³

et al. 2022

Cureus

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Patients with cardiac and thoracic trauma remain one of the most difficult presentations to diagnose and treat in an emergency room setting. Here, we present our series of four cases of cardiac and thoracic trauma with varied presentations, including lung, vascular, and diaphragmatic injuries that were managed successfully. We further review the manifestations of cardiac trauma, including cardiac contusions, cardiac rupture, pericardial injury, and valvular injuries; thoracic trauma, including lung and diaphragmatic injury. The sheer complexity of the anatomical structures within the thorax makes it of the utmost importance to timely and appropriately manage them.

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“…Troponins have been shown to be useful for prognosis after trauma [ 20 ], but they are not highly specific for MI. Troponins are specific for injury to cardiac rather than skeletal muscle, but they often represent myocardial injury rather than type 1 MI.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Predictors of Myocardial Infarction in Trauma With Development of a Trauma Cardiac Risk Index

Culhane¹,

Mangold²,

Freeman³

2021

Cureus

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Study objective: Trauma has historically been considered a disorder of the young and healthy, with a low risk of cardiac ischemia; hence most research on myocardial infarction in trauma has focused on direct cardiac damage from blunt chest trauma. However, the age and comorbidity of trauma patients are increasing, making the trauma population more vulnerable to myocardial infarction (MI). Cardiac risk assessment has emphasized morbidity and mortality in an elective surgical setting, but it is also important in acute trauma. Our study analyzes the risk factors for MI in a trauma population to create a scoring system to predict the risk of MI. Design: Retrospective cohort analysis of a national trauma registry over a five-year period. Potential predictors of MI in trauma patients were identified and tested with univariate and multivariate statistics. A numerical score was created to predict the risk of MI based on these criteria. Setting: The National Trauma Data Bank (NTDB) is a large registry of selected trauma centers in the United States. Data include demographic, injury, treatment, and outcome variables pertaining to the index admission of each patient. The institutions range from community hospitals through level 1 trauma centers. The time period is the entire inpatient hospital admission from arrival from the field, through the emergency department, ICU, and floor up to discharge. Patients: 3,437,959 trauma patients aged 18 years and older from various US trauma centers. 62.8% were male. The median age is 50 years with a standard deviation of 21.25. The median Injury Severity Score is 9 with a standard deviation of 9.04. Measurements: Demographic, traumatic, and comorbidity variables were collected from the NTDB. The primary outcome was MI during the initial trauma admission. Multivariate analysis was performed with logistic regression. Main results: Over 8010 (0.23%) suffered an MI. The strongest risk factors for MI were a history of MI with an adjusted odds ratio (OR) of 7.0, and angina with an OR of 3.4. A procedure under general anesthesia (GA) conferred an OR of 2.3. Minor risk factors included torso injury and 10-year age interval over 50, both with an OR of 1.7, a 20-point interval of the Injury Severity Score (ISS) with OR 1.6, male gender with OR of 1.5, and various chronic disease comorbidities with OR ranging from 1.4 to 1.9. A Trauma Cardiac Risk Index (TCRI) was derived from these risk factors. The model showed good discrimination with a C statistic of 0.85. Conclusions: Overall the trauma population has a low risk of MI. However, the risk is much higher for older patients with chronic comorbidity. The TCRI can be used to assess cardiac risk in trauma patients to help direct monitoring, testing, and risk reduction measures to those at the highest risk.

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Prognostic Value of Cardiac Troponin I and T on Admission in Mortality of Multiple Trauma Patients Admitted to the Emergency Department: a Prospective Follow-up Study

Cited by 8 publications

References 24 publications

Modeling Cardiac Dysfunction Following Traumatic Hemorrhage Injury: Impact on Myocardial Integrity

Modeling Cardiac Dysfunction Following Traumatic Hemorrhage Injury: Impact on Myocardial Integrity

Management of Thoracic and Cardiac Trauma: A Case Series and Literature Review

Analysis of Predictors of Myocardial Infarction in Trauma With Development of a Trauma Cardiac Risk Index

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