Assessment of Prevalence and Prognostic Value of Acute Myocardial Dysfunction in Severe Trauma Patients With Chest Trauma Using 2D-strain Ultrasound: A Prospective Observational Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 150
- 试验地点
- 1
- 主要终点
- Occurrence of an a segmental or global acute myocardial dysfunction
研究概览
简要总结
This study aims to investigate whether the identification of acute myocardial dysfunction by 2D-strain transthoracic sonography in the first week following trauma would allow to better diagnose occult and severe patterns of myocardial contusion, in order to identify a subpopulation at higher risk of complications.
The measurement of myocardial strain (2D-strain) by transthoracic sonography is a robust tool to assess the myocardial function.
The investigators strongly suppose that the 2D-strain would allow to better identify subclinical MC in chest trauma, as well as the severe patterns that are associated with more organs dysfunctions and a worst outcome.
详细描述
Thoracic trauma is the cause of significant morbidity and accounts for 25% of trauma-related deaths.
The myocardial contusion (MC) is a distinct injury, which has a prevalence increasing with the severity of the trauma. The diagnostic tool is a major factor to vary the prevalence of MC (i.e. clinical exam, biology, electrocardiogram), with the highest values for autopsy series, until 24% of patients. It does not exist therefore of gold standard for the diagnosis of MC in clinical practice leading to a modest knowledge of this nosological entity. In clinical practice, troponin plasma level determines the diagnostic.
Otherwise, the measurement of myocardial strain (2D-strain) by transthoracic echocardiography (TTE) is a robust tool to assess the myocardial function. This ultrasound analysis allows an objective and topographical quantification of an acute myocardial dysfunction, be it global or segmental. 2D-strain has been thus has been validated for the diagnosis of myocardial dysfunction in medical setting. Its use in trauma setting has never been reported.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 74 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •severe trauma patients with blunt chest trauma
- •(AIS Thorax score ≥ 1)
- •admitted in our trauma intensive care unit
- •and included within the 24 first hours following trauma
排除标准
- •Imminent death
- •Recovered cardiocirculatory arrest following trauma
- •Critical patient : AIS score ≥5 on 1 lesion, requiring ECLS (extracorporeal life support) or REBOA (resuscitative endovascular balloon occlusion of the aorta)
- •Refractory hypovolaemia
- •Arrhythmia, atrial fibrillation
- •Congenital heart disease, ischemic cardiomyopathy, moderate or severe pre-existing valvular heart disease, pulmonary arterial hypertension (PAH)
- •Valve prosthesis or pacemaker
- •Insufficient quality of ultrasound image to allow correct assessment of 2D-strain
- •Pregnant woman and underage patients
结局指标
主要结局
Occurrence of an a segmental or global acute myocardial dysfunction
时间窗: In the first week following trauma
Using transthoracic echocardiography to assess the myocardial function
次要结局
未报告次要终点