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Master Thesis

Prevalence and prognosis of early post-traumatic myocardial dysfunction assessed by 2D STE in blunt chest trauma: insights from the STRAINY TRAUMA trial. A prospective observational exploratory study

Abstract : Background: Myocardial Contusion is one of the most described injuries described in blunt chest trauma. Its clinical characteristics and prevalence remain poorly known. Strain measurement using 2D speckle-tracking echocardiography (2D STE) may quantify subtle abnormalities of myocardial function but has never been studied in trauma setting. We hypothesize that 2D STE can be used as a sensitive tool in the early recognition of post-traumatic myocardial dysfunction (PTMD). The aim of this study was therefore to determine prevalence of PTMD assessed by 2D STE in chest trauma patients on Day 1. Methods: a prospective observational study was carried out in the Trauma Center from May to October 2021 (IRB N°202000542). All severe trauma patients suffering from a blunt chest injury (AIS≥1) were consecutively enrolled within the first 24 hours of trauma. Echocardiography (conventional parameters and 2D STE) was performed on Day 1, Day 2 and Day 7, as well cardiac biomarkers and electrocardiogram. Prevalence of left PTMD (GLS> -18%) and right PTMD (free-wall LS> -20%) on Day 1 was specifically studied, as well as its course and its prognostic consequences. Results: of 105 chest trauma patients admitted, 44 were included in the interim analysis planned at 6 months (median age 35 (IQR, 27‒55), median ISS 29 (IQR, 17‒34)). Prevalence of PTMD on Day 1 was 67% (95% CI 52‒82%): 44% (95% CI 28‒59%) left PTMD, 5% (95% CI 0‒12%) right PTMD, 18% (95% IC 6-30%) bilateral PTMD. In these patients, left ventricular GLS on Day 1 was -15% (IQR, -16‒ -13%) and right ventricular free-wall LS -13% (IQR, -16‒ -12%). On Day 2 all patients conserved a PTMD , with an increase in left ventricular GLS value of 6% (IQR, -7‒18%) and a decrease in right ventricular free-wall LS value of 5% (IQR, -16‒30%). On Day 7, 20 patients (61%) presented a persistent PTMD: 15 (46%) on the left side, 2 (6%) on the right side and 3 bilateral (9%). Finally, patient with PTMD had a significant higher morbidity in comparison with others chest trauma patients (norepinephrine use [P=0.01], duration of vasopressor support [P=0.02] or length of hospital stay [P=0.05]. Conclusion: in this interim analysis, prevalence of PTMD detected by 2D STE was very high in our cohort severe blunt chest trauma patients. This suggest that myocardial strain would be an interesting diagnostic tool to early detect subclinical patterns of myocardial contusion associated with a worse outcome.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03524838
Contributor : Faculté de Médecine Um Connect in order to contact the contributor
Submitted on : Thursday, January 13, 2022 - 2:46:46 PM
Last modification on : Wednesday, January 26, 2022 - 3:13:04 AM
Long-term archiving on: : Thursday, April 14, 2022 - 6:56:18 PM

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Élodie Brun. Prevalence and prognosis of early post-traumatic myocardial dysfunction assessed by 2D STE in blunt chest trauma: insights from the STRAINY TRAUMA trial. A prospective observational exploratory study. Human health and pathology. 2021. ⟨dumas-03524838⟩

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