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Titolo:
Evaluation of incidence, clinical significance, and prognostic value of circulating cardiac troponin I and T elevation in hemodynamically stable patients with suspected myocardial contusion after blunt chest trauma
Autore:
Bertinchant, JP; Polge, A; Mohty, D; Nguyen-Ngoc-Lam, R; Estorc, J; Cohendy, R; Joubert, P; Poupard, P; Fabbro-Peray, P; Monpeyroux, F; Poirey, S; Ledermann, B; Raczka, F; Brunet, J; Nigond, J; de la Coussaye, JE;
Indirizzi:
Univ Nimes Hosp, Dept Cardiol, F-30900 Nimes 4, France Univ Nimes Hosp Nimes France 4 sp, Dept Cardiol, F-30900 Nimes 4, France Univ Nimes Hosp, Dept Biochem, F-30900 Nimes, France Univ Nimes Hosp Nimes France F-30900 Dept Biochem, F-30900 Nimes, France Univ Nimes Hosp, Dept Biostat & Epidemiol, F-30900 Nimes 4, France Univ Nimes Hosp Nimes France 4 stat & Epidemiol, F-30900 Nimes 4, France Univ Nimes Hosp, Div Trauma & Emergency Med Serv, F-30900 Nimes 4, France Univ Nimes Hosp Nimes France 4 ergency Med Serv, F-30900 Nimes 4, France
Titolo Testata:
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE
fascicolo: 5, volume: 48, anno: 2000,
pagine: 924 - 931
Fonte:
ISI
Lingua:
ENG
Soggetto:
CREATINE-KINASE-MB; SKELETAL-MUSCLE; MARATHON RUNNERS; INJURY; INFARCTION; DIAGNOSIS; ADULT; ECHOCARDIOGRAPHY; SPECIFICITY; TROPOMYOSIN;
Keywords:
cardiac troponin I; cardiac troponin T; myocardial contusion; late outcome;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
48
Recensione:
Indirizzi per estratti:
Indirizzo: Bertinchant, JP Univ Nimes Hosp, Dept Cardiol, 5 Rue Hoche, F-30900 Nimes 4, France Univ Nimes Hosp 5 Rue Hoche Nimes France 4 imes 4, France
Citazione:
J.P. Bertinchant et al., "Evaluation of incidence, clinical significance, and prognostic value of circulating cardiac troponin I and T elevation in hemodynamically stable patients with suspected myocardial contusion after blunt chest trauma", J TRAUMA, 48(5), 2000, pp. 924-931

Abstract

Background: The frequency and prognostic influence of myocardial injury inpatients with blunt chest trauma is controversial. We investigated the value of cardiac troponin I (cTn-I) and cardiac troponin T (cTn-T), highly specific markers of myocardial injury, to determine whether their measurement would improve the ability to detect myocardial contusion in stable patientswith blunt chest trauma in comparison with conventional markers and whether they, were associated with significantly worse late clinical outcome. Methods and Results: Over an 18-month period, myocardial contusion was diagnosed in 26 of 94 patients (27.6%) with acute blunt chest trauma (motor vehicle trash; 81%), because of echocardiographic abnormalities (n = 12), electrocardiographic abnormalities in = 29), or both, Patients with myocardialcontusion had a significantly higher Injury Severity Score at the time of admission (p = 0.001) and a significantly longer hospital stay (p = 0.0008). All patients survived admission to hospital and n ere hemodynamically stable. None of the patients died or had severe in-hospital cardiac complications, The percentage of patients with elevated CK, (CK-MB/total CK) ratio, or CK-MB mass concentration was not significantly different between patientswith or without myocardial contusion, However, there were significant differences between the two groups when we applied the commonly used threshold levels of CK-MB LB activity and myoglobin, The percentage of patients with elevated circu- lating cTn-I and cTn-T (greater than or equal to 0.1 mu g/L) was significantly higher in patients with myocardial contusion (23% vs, 3%;p = 0.01 and 12% vs. 0%;p = 0.03, respectively). Complete changes in cTn-I and cTn-T correlated well (r = 0.91, p = 0.0001), Sensitivity, specificity, and negative and positive predictive values of cTn-I and cTn-T in predicting a myocardial contusion in blunt trauma patients were 23%, 97%, and 77%, 75%, and 12%, 100%, and 74%, 100%, respectively, Clinical follow-up was available in 83 patients (88%) (mean, 16 +/- 7.5 months). There were no deaths in either group directly attributed to cardiac complications. None of the patients had any long-term cardiac complications or myocardial failure related to blunt chest trauma. Conclusion: Although improved specificity of cTn-I and cTn-T compared withconventional markers, it should be emphasized that the main problem,vith cTn-I and cTn-T is low sensitivity as well as low predictive values in diagnosing myocardial contusion, cTn-I and cTn-T measurement is currently not animproved method in diagnosing blunt cardiac injury in hemodynamically stable patients, Moreover, there was no association of postmyocardial contusioncell injury and late outcome in these patients when cTn-I and cTn-T and other conventional markers were considered.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/09/20 alle ore 10:33:29