Related Experiment Videos
Improved detection of cardiac contusion with cardiac troponin I
J E Adams1, V G Dávila-Román, P Q Bessey
1Department of Surgery, Washington University School of Medicine, St. Louis, USA.
Insights
Diagnosing cardiac injury in chest trauma patients is challenging. Cardiac troponin I (cTnl) accurately detects heart injury, unlike creatine kinase MB isoenzyme (MBCK), improving diagnosis in blunt chest trauma.
Area of Science:
- Cardiology
- Biochemistry
- Trauma Medicine
Background:
- Detecting cardiac injury in chest trauma is difficult due to elevated creatine kinase MB isoenzyme (MBCK) from skeletal muscle injury.
- Cardiac troponin I (cTnl) is not affected by skeletal muscle injury, offering a potential diagnostic advantage.
Purpose of the Study:
- To evaluate the utility of cardiac troponin I (cTnl) in detecting cardiac injury in patients with blunt chest trauma.
- To compare the diagnostic performance of cTnl with MBCK in this patient population.
Main Methods:
- Studied 44 patients with blunt chest trauma.
- Obtained serial echocardiograms and blood samples for biomarker analysis.
- Assessed levels of MBCK and cTnl.
Main Results:
- Six patients showed echocardiographic evidence of cardiac injury, all with elevated MBCK and cTnl.
- Twenty-six patients without contusion had elevated MBCK, but none had elevated cTnl.
- cTnl measurement accurately identified cardiac injury, whereas MBCK elevations were common in non-cardiac skeletal muscle injury.
Conclusions:
- Cardiac troponin I (cTnl) measurement accurately detects cardiac injury in blunt chest trauma patients.
- cTnl facilitates improved diagnosis and management of cardiac injury in trauma settings.
- MBCK is less specific for cardiac injury due to confounding skeletal muscle involvement.
Abstract:
Detecting cardiac injury in patients with chest trauma is difficult because the level of the MB isoenzyme of creatine kinase (MBCK) can be elevated from skeletal muscle injury alone. However, the level of cardiac troponin I (cTnl) is not elevated by skeletal muscle injury. To determine whether its measurement would improve the ability to detect cardiac injury in patients with blunt chest trauma, 44 patients were studied. Serial echocardiograms and serial blood samples were obtained. Six patients had evidence of cardiac injury by echocardiography; all had elevations of MBCK and cTnl. One patient had elevations of both MBCK and cTnl with only a pericardial effusion. Twenty-six of the 37 patients without contusion had elevations of MBCK; none had elevations of cTnl. The ratio of MBCK to total creatine kinase improved specificity at the expense of sensitivity. Measurement of cTnl accurately detects cardiac injury in patients with blunt chest trauma and should facilitate the diagnosis and management of such patients.