Evaluation of Myocardial Injury using Standard Diagnostic Tools and Tissue Doppler Imaging in Blunt Trauma Chest
Parshotam Lal Gautam1, Neeru Luthra2, Manpreet Kaur3
1Professor, Department of Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Insights
Diagnosing myocardial contusion after chest trauma is challenging. Tissue Doppler imaging, alongside echocardiography, offers valuable insights into cardiac injury, improving diagnostic accuracy for blunt chest trauma patients.
Area of Science:
- Cardiology
- Trauma Medicine
- Diagnostic Imaging
Background:
- Myocardial contusion diagnosis in chest trauma is difficult, lacking a gold standard test.
- Current diagnostic methods rely on cardiac biomarkers and standard echocardiography.
- Tissue Doppler imaging (TDI) has not been extensively explored for this condition.
Purpose of the Study:
- To evaluate cardiac injury in blunt chest trauma patients.
- To compare conventional echocardiography parameters with Tissue Doppler imaging.
Main Methods:
- Prospective study of 30 blunt chest trauma patients (15-60 years).
- Inclusion criteria: positive Trop-T, elevated CPK (> 308 IU/L), and CK-MB (> 24 IU/L).
- All patients underwent 2D-echocardiography and Tissue Doppler Imaging; data analyzed using chi-square test.
Main Results:
- 63.3% of patients showed ECG changes indicative of cardiac injury.
- Systolic dysfunction observed in 76.7% and diastolic dysfunction in 36.6% of patients.
- Statistically significant difference (p=0.04) found when comparing E wave (echocardiography) and Em wave (TDI) at the tricuspid valve.
Conclusions:
- Echocardiography is a sensitive tool for assessing myocardial contusion.
- Tissue Doppler imaging provides supplementary and dependable information for diagnosing cardiac injury in trauma.
Introduction:
Myocardial contusion is an entity in chest trauma which is difficult to diagnose. Current practice relies more on cardiac-specific biochemical markers and standard echocardiography, but no gold standard test exists. The application of Tissue Doppler imaging is yet unexplored.
Aim:
The present study was designed to evaluate cardiac injury in patients with blunt trauma chest using conventional trans-thoracic echocardiography parameters and Tissue Doppler imaging.
Materials And Methods:
After ethical approval was taken from the Hospital and University and a written informed consent from all patients/attendants, this prospective study was conducted on a total of 30 patients in range of 15-60 years of age with blunt trauma chest. Patients with positive Trop-T and raised CPK (> 308 IU/L), raised CK-MB (> 24 IU/L) levels were suspected to have myocardial injury and were enrolled in the study. All patients fulfilling the inclusion criteria then underwent 2D-Echo and Tissue Doppler Imaging. Results of the observations were analysed using chi-square test.
Results:
Out of the total of 30 patients, 63.3% showed ECG changes suggestive of cardiac injury. A 76.7% patients suffered systolic dysfunction and 36.6% patients suffered diastolic dysfunction irrespective of ECG changes. On comparison of early filling velocity wave i.e., E wave (measured by transthoracic echocardiography) and tricuspid annular velocity Em wave (measured by tissue Doppler echocardiography) at tricuspid valve, we found statistically significant difference among two techniques. (p = 0.04).
Conclusion:
Echocardiography is very sensitive parameter for evaluation of myocardial contusion. Tissue Doppler imaging provides additional and reliable information.
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