Acute Myocardial Dysfunction and Chest Trauma - The Strainy Trauma Study

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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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

Conditions
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Chest Trauma

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 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 Exclusion Criteria: 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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 74 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence of an a segmental or global acute myocardial dysfunction | Using transthoracic echocardiography to assess the myocardial function | In the first week following trauma | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Severe trauma, chest trauma