Role of transesophageal echocardiography in the assessment of patients with blunt chest trauma: Correlation of echocardiographic findings with the electrocardiogram and creatine kinase monoclonal antibody measurements,☆☆,

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Abstract

Objectives: This study was designed to evaluate the usefulness of transesophogeal echocardiography (TEE) for detecting cardiac damage after blunt chest trauma (BCT). Background: Multiple methods have been used to detect cardiac damage after a BCT, but none has been demonstrated to be sensitive, specific, and feasible enough. Methods: This multicenter prospective trial was designed to evaluate the usefulness of TEE in the assessment of patients with BCT and to compare the TEE findings with those provided by the electrocardiogram (ECG) and cardiac isoenzymes assay. One hundred seventeen consecutive patients with a significant BCT were enrolled. A TEE was performed in each patient. Serial ECGs and plasma profiles of creatine kinase (CK) and CK-monoclonal antibody (MB) were obtained. Results: Sixty-six (56%) patients had pathologic findings in the TEE attributed to the BCT (group A). In the remaining 51 (44%) patients the TEE was normal (group B). An abnormal ECG was more frequent in group A (59% vs 24%; p < 0.001), and the serum CK-MB peak level was also higher in group A (174 ± 30 U/L vs 93 ± 21 U/L; p = 0.05). Relative to pathologic TEE findings, the sensitivity and specificity of an abnormal ECG were 59% and 73% and of high CK-MB with CK-MB/CK >5% were 64% and 52%, respectively. Conclusions: We conclude that TEE can be routinely and safely performed for diagnosing cardiac injuries after a BCT and plays an important role in the evaluation and treatment of these patients. EGG and CK-MB assay are not good methods for detecting cardiac damage in this setting. (Am Heart J 1998;135:476-81.)

Section snippets

Methods

This study was a multicenter prospective trial designed to evaluate the usefulness of TEE in the assessment of patients with BCT and to compare the TEE findings with those provided by other routine techniques like EGG and cardiac isoenzymes assay. The trial began on January 1993 and was concluded on April 1995. Three centers participated in the study: “Gregorio Marañón" General Hospital, “Juan Canalejo" Hospital, and Galicia General Hospital.

TEE

Of 117 patients with BCT enrolled in this study, 66 (56%) showed pathologic findings on TEE (group 1). In the remaining 51 (44%) patients TEE was normal or disclosed findings not attributable to the trauma (group 0). No differences were found in age (37 ± 2 years and 38 ± 2 years, respectively) nor in sex (men, 76% and 78%, respectively) between the two groups. The pathologic echocardiographic findings are listed in Table I.

. Findings of TEE

Empty CellnPercent
Myocardial
 Abnormal regional wall motion
  Right

Discussion

BCT frequently results in cardiac damage. In our study, as in other previous works,5 clinical findings, ECG, and CK-MB levels did not predict the patients who had cardiac injuries. We conclude that TEE can be routinely and safely performed for diagnosing cardiac lesions in this setting and plays an important role in the evaluation and treatment of this type of patient.

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    From the aLaboratory of Echocardiography, Department of Cardiology, and the bIntensive Care Unit, “Gregorio Marañón” General Hospital, Madrid, the cIntensive Care Unit, “Juan Canalejo” Hospital, La Coruña, and the dDepartment of Cardiology, Galicia General Hospital, La Coruña.

    ☆☆

    Reprint requests: Miguel A. García-Fernández, MD, Hospital General Universitario “Gregorio Marañón”, Laboratorio de Ecocardiografía, Departamento de Cardiología, Doctor Esquerdo 46, 28007-Madrid, Spain.

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