From the Guidelines
The best study to screen for cardiac contusion in addition to an electrocardiogram (ECG) is a transthoracic echocardiogram (TTE). This is based on the most recent and highest quality evidence from the American College of Radiology, which recommends TTE as a first-line imaging modality in the evaluation of patients with suspected blunt cardiac trauma presenting with abnormal ECG and elevated cardiac troponin level 1. TTE can easily assess the biventricular systolic function, pericardial effusion with suspected tamponade, myocardial rupture, wall motion abnormality, septal injuries, and valvular injuries in the setting of blunt chest trauma.
Some key points to consider when using TTE for cardiac contusion screening include:
- TTE can detect pericardial effusion, myocardial contusion or laceration, regional wall motion abnormalities, acute valvular regurgitation, and aortic dissection in patients with severe deceleration injury or chest trauma 1.
- If echocardiography findings are suboptimal for evaluation of myocardial rupture, further evaluation with cardiac CT or transesophageal echocardiography (TEE) is warranted 1.
- TEE is superior to TTE in the assessment of traumatic cardiac injury, but TTE is often more readily available and can provide valuable information for initial screening 1.
Overall, TTE is a valuable tool for screening for cardiac contusion in patients with blunt chest trauma, and its use is supported by recent and high-quality evidence 1.
From the Research
Screening for Cardiac Contusion
In addition to an electrocardiogram (ECG), the best study to screen for cardiac contusion is:
- Cardiac troponin I and T measurement, as they have been found to be highly sensitive for myocardial injury 2, 3, 4
- Transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) can also be used to detect myocardial contusion, with TEE being more sensitive than TTE 5, 6
Diagnostic Tests
The following diagnostic tests can be used to screen for cardiac contusion:
- ECG: to detect arrhythmias and other cardiac abnormalities
- Cardiac troponin I and T measurement: to detect myocardial injury
- TTE or TEE: to detect segmental wall motion abnormalities and other cardiac structural abnormalities
- Biochemical cardiac markers: such as CK-MB and myoglobin, although they have lower sensitivity and specificity than cardiac troponin I and T 4
Study Comparison
A comparison of the studies shows that:
- Cardiac troponin I and T measurement has high sensitivity and specificity for myocardial injury, but low sensitivity and predictive values for diagnosing myocardial contusion in hemodynamically stable patients 4
- TEE is more sensitive than TTE in detecting cardiac contusion, especially in patients with suboptimal TTE image quality 5, 6