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Circulating Cardiac Troponin T in Myocardial Contusion

Mustapha Ferjani; Gabriella Droc; Sophie Dreux; Martine Arthaud; Jean-Pierre Goarin; Bruno Riou; Pierre Coriat
Author and Funding Information

From the Département d'Anesthésie-Réanimation, and Laboratoire de Biologie des Urgences, Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, Paris, France


1997 by the American College of Chest Physicians


Chest. 1997;111(2):427-433. doi:10.1378/chest.111.2.427
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Abstract

Study objective: Myocardial contusion may induce life-threatening complications, but its diagnosis is difficult. Circulating cardiac troponin T is considered a highly sensitive and specific marker of myocardial cell injury. We investigate the value of cardiac troponin T measurement in the diagnosis of myocardial contusion.

Design: Prospective study.

Setting: Level 1 trauma center

Methods: We prospectively measured circulating cardiac troponin T and performed echocardiography and continuous Holter monitoring in patients who had suffered blunt trauma. Myocardial contusion was diagnosed in patients who fulfilled one of the following criteria: (1) an abnormal echocardiography compatible with myocardial contusion; (2) severe cardiac rhythm abnormalities; (3) severe cardiac conduction abnormalities; and (4) hemopericardium.

Measurements and results: One hundred twenty-eight patients were included and myocardial contusion was diagnosed in 29 patients. Patients with myocardial contusion had more severe trauma, experienced more frequently associated thoracic lesions, and had a lower left ventricular ejection fraction area (48±15 vs 61±10%; p<0.001). Elevated circulating cardiac troponin T concentrations were significantly more frequent in patients with a myocardial contusion (31 vs 9%; p<0.007). An elevated circulating cardiac troponin T concentration (≥0.5 µg/L) was more accurate than MB fraction of creatine kinase (CK) (CK-MB) and CK-MB/CK ratio in the diagnosis of myocardial contusion, as shown by an area under the receiver operating characteristic (ROC) curve (AROC), which was significantly different from 0.50 (AROC=0.69; 95% confidence interval, 0.56 to 0.80). However, this improvement was not clinically acceptable (sensitivity, 0.31; specificity, 0.91).

Conclusions: Circulating cardiac troponin T measurement had a slightly greater diagnostic value than usual biological parameters (CK-MB, CK-MB/CK) in myocardial contusion. Nevertheless, it was concluded that an elevated circulating cardiac troponin T concentration has no important clinical value in the diagnosis of myocardial contusion.


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