Sztulman Larissa, Ritter Aileen, de Rosa Roberta, Pfeiffer Victoria, Leppik Liudmila, Busse Lewin-Caspar, Kontaxi Elena, Störmann Philipp, Verboket René, Adam Elisabeth, Marzi Ingo, Weber Birte
Department of Trauma Surgery and Orthopedics, Goethe University Frankfurt, University Hospital, 60590, Frankfurt, Germany.
Department of Cardiology, Goethe University Frankfurt, University Hospital, 60590, Frankfurt, Germany.
World J Emerg Surg. 2025 Mar 11;20(1):21. doi: 10.1186/s13017-025-00596-5.
Heart injuries following polytrauma (PT) are identified as a predictor of poor outcome. The diagnostic algorithm of cardiac damage after trauma consists of the systemic measurement of cardiac damage markers, a 3-channel ECG and if there are any suspicious findings, the conduction of a transthoracic echocardiography (TTE). The aim of this study was to implement a systematic analysis of cardiac function using TTE in PT-patients.
This study is a prospective non-randomized study, conducted in a German Level 1 Trauma Centre between January and July 2024. All polytraumatized patients with an ISS ≥ 16 were included immediately after entering the emergency department. Blood samples were withdrawn at 6 timepoints, at the Emergency room, 24 h, 48 h, three, five and ten days after admission to the hospital. Cardiac damage was measured by Troponin T (TnT) ECLIA, as well as NT-proBNP measurements. Entering the intensive care unit, transthoracic echocardiography was performed at two time points (day 1 and 2), by an experienced Cardiologist.
During the pilot phase, cardiac contusion was detected in 14.3% of patients, with significantly elevated TnT levels on arrival, after 24 (**p ≤ 0.01) and 48 h (*p ≤ 0.05) compared to patients without cardiac contusion. Echocardiographic findings revealed that 25% of all patients had wall motion abnormalities, and 20% showed relaxation disorders. Right ventricular function, measured by TAPSE (tricuspid annular plane systolic excursion), RVEDD (right ventricular end diastolic diameter) and sPAP (systolic pulmonary arterial pressure), was slightly impaired in trauma patients, while the left ventricular function (ejection fraction (EF) and left ventricular end diastolic diameter (LVEDD)) was preserved. We observed the increase of TnT and an increase of the heart failure marker NT-proBNP over the time. These biomarkers were associated with pre-existing cardiac risk factors, the ISS and changes in the right or left ventricular function. Mitral valve insufficiency (grade 1) was present in 50% and tricuspid valve (grade 1) insufficiency in 30%.
Taken together, we conducted for the first time of our knowledge, a systematic TTE analysis in PT-patients. We observed a slightly reduced right ventricular function, as well as mitral and tricuspid valve regurgitations in the patients.
多发伤（PT）后的心脏损伤被认为是预后不良的一个预测指标。创伤后心脏损伤的诊断算法包括对心脏损伤标志物进行系统检测、进行三通道心电图检查，以及如果有任何可疑发现，则进行经胸超声心动图（TTE）检查。本研究的目的是使用TTE对多发伤患者的心脏功能进行系统分析。
本研究是一项前瞻性非随机研究，于2024年1月至7月在德国一级创伤中心进行。所有损伤严重度评分（ISS）≥16的多发伤患者在进入急诊科后立即被纳入研究。在6个时间点采集血样，分别是在急诊室、入院后24小时、48小时、三天、五天和十天。通过肌钙蛋白T（TnT）电化学发光免疫分析以及N末端脑钠肽前体（NT-proBNP）检测来测量心脏损伤。进入重症监护病房时，由一位经验丰富的心脏病专家在两个时间点（第1天和第2天）进行经胸超声心动图检查。
在试验阶段，14.3%的患者被检测出有心脏挫伤，与没有心脏挫伤的患者相比，在到达时、24小时（**p≤0.01）和48小时（*p≤0.05）后TnT水平显著升高。超声心动图检查结果显示，所有患者中有25%存在室壁运动异常，20%表现出舒张功能障碍。通过三尖瓣环平面收缩期位移（TAPSE）、右心室舒张末期内径（RVEDD）和肺动脉收缩压（sPAP）测量的右心室功能在创伤患者中略有受损，而左心室功能（射血分数（EF）和左心室舒张末期内径（LVEDD））保持正常。我们观察到随着时间推移TnT升高以及心力衰竭标志物NT-proBNP升高。这些生物标志物与既往存在的心脏危险因素、ISS以及右心室或左心室功能变化有关。50%的患者存在二尖瓣关闭不全（1级），30%的患者存在三尖瓣关闭不全（1级）。
综上所述，据我们所知，我们首次对多发伤患者进行了系统的TTE分析。我们观察到患者的右心室功能略有降低，以及二尖瓣和三尖瓣反流。
