Circulating cardiac troponin T in myocardial contusion.
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.


METHODS
Prospective study.


METHODS
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.


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 (> or = 0.5 microgram/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.
Ferjani
M
M
Département d'Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris VI University, France.
Droc
G
G
Dreux
S
S
Arthaud
M
M
Goarin
J P
JP
Riou
B
B
Coriat
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D009202:Cardiomyopathies / Q000097:blood*; D003288:Contusions / Q000097:blood*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood*; D020107:Troponin T
D015415:Biomarkers; D007527:Isoenzymes; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase