Cardiac magnetic resonance imaging in suspected blunt cardiac injury: A prospective, pilot, cohort study.
BACKGROUND
The aim of this study was to evaluate the incidence and severity of blunt cardiac injury (BCI) as determined by cardiac magnetic resonance imaging (CMR), and to compare this to currently used diagnostic methods in severely injured patients.


METHODS
We conducted a prospective, pilot cohort study of 42 major trauma patients from July 2013 to Jan 2015. The cohort underwent CMR within 7 days, enrolling 21 patients with evidence of chest injury and an elevated Troponin I compared to 21 patients without chest injury who acted as controls. Major adverse cardiac events (MACE) including ventricular arrhythmia, unexplained hypotension requiring inotropes, or a requirement for cardiac surgery were recorded.


RESULTS
6/21 (28%) patients with chest injuries had abnormal CMR scans, while all 21 control patients had normal scans. CMR abnormalities included myocardial oedema, regional wall motion abnormalities, and myocardial haemorrhage. The left ventricle was the commonest site of injury (5/6), followed by the right ventricle (2/6) and tricuspid valve (1/6). MACE occurred in 5 patients. Sensitivity and specificity values for CMR at predicting MACE were 60% (15-95) and 81% (54-96), which compared favourably with other tests.


CONCLUSIONS
In this pilot trial, CMR was found to give detailed anatomic information of myocardial injury in patients with suspected BCI, and may have a role in the diagnosis and management of patients with suspected BCI.
The Intensive Care Unit, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia. Electronic address: aidanburrell@gmail.com.
Aidan Jc
AJ
Burrell
The Department of Cardiovascular Medicine, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Australia.
David M
DM
Kaye
The Department of Trauma, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia.
Mark C
MC
Fitzgerald
The Intensive Care Unit, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne 3004, VIC, Australia.
David J
DJ
Cooper
The Department of Cardiovascular Medicine, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Australia.
James L
JL
Hare
BakerIDI Heart and Diabetes Institute, Melbourne, Australia.
Benedict T
BT
Costello
The Department of Cardiovascular Medicine, Alfred Hospital, 55 Commercial Road, Melbourne 3181, VIC, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Australia.
Andrew J
AJ
Taylor
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000209:etiology; D001315:Australia / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D008297:Male; D000071956:Myocardial Contusions / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology; D010865:Pilot Projects; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I
Blunt cardiac injury (BCI); Cardiac contusion; Cardiac imaging; Cardiac magnetic resonance imaging (CMR); Echocardiography; Thoracic trauma