Volume 22 Supplement 1

London Trauma Conference 2013

Open Access

The role of inflammation in secondary cardiac dysfunction following trauma

  • Nick M Wilson1,
  • Henry D De’Ath1 and
  • Joanna Manson1
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine201422(Suppl 1):P12

DOI: 10.1186/1757-7241-22-S1-P12

Published: 7 July 2014

Background

Recent evidence supports the existence of a trauma induced secondary cardiac injury (TISCI) that is associated with poor clinical outcome [1]. Cardiac dysfunction has been demonstrated as early as 30mins after injury and is characterised by reduced contractility that is unresponsive to increased perfusion and preload [2].Inflammation is implicated as a key aetiological factor [1, 3]. This review aims to evaluate current knowledge on cardiac inflammation after trauma and highlight mechanisms for future study.

Method

A literature search for studies pertaining to cardiac inflammation after mechanical trauma (T), haemorrhagic shock (HS) or both combined (THS) was performed.

Results

The search identified 1 clinical and 25 pre-clinical studies for inclusion.

Following T/HS and THS there is an increase in cardiomyocyte interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-a) and nuclear factor Kappa-B (NFKB). A rise in intracellular adhesion molecule-1 (ICAM-1) expression in cardiac tissue has also been observed. Neutrophil infiltration of cardiac tissue has been observed 6h after injury. Following T/HS and THS cardiac inducible nitric oxide synthase (iNOS) and nicotinamide adenine dinucleotide phosphate-oxidase (NADPH) levels increases suggested to be associated with a rise in reactive oxygen and nitrogen species. In addition, significant levels of apoptosis have been observed peaking at 12h following injury.

Pharmacological agents including oestrogen and insulin have been shown to reduce cardiac inflammation and prevent contractile dysfunction. The precise mechanism of this cardio-protection is yet unknown but involvement in preventing oxidative and nitrative stress is apparent.

Conclusion

Cytokine production, cell activation, neutrophil infiltration and production of reactive oxygen and nitrogen species have been observed in cardiac tissues after trauma with corresponding reduction in intrinsic myocardial contractility. This review has highlighted some mechanisms which require further study if we are to understand the complex clinical sequelae of trauma and possibly develop novel therapeutics.

Authors’ Affiliations

(1)
Trauma Sciences, Queen Mary University

References

  1. De'Ath HD, Manson J, Davenport R, Glasgow S, Renfrew I, Davies LC: Trauma-induced secondary cardiac injury is associated with hyperacute elevations in inflammatory cytokines. Shock. 2013, 39 (5): 415-20. 10.1097/SHK.0b013e31828ded41.View ArticlePubMedGoogle Scholar
  2. Shahani R, Klein LV, Marshall JG, Nicholson S, Rubin BB, Walker PM: Hemorrhage-induced alpha-adrenergic signaling results in myocardial TNF-alpha expression and contractile dysfunction. Am J Physiol Heart Circ Physiol. 2001, 281 (1): H84-92.PubMedGoogle Scholar
  3. Kher A, Wang M, Tsai BM, Pitcher JM, Greenbaum ES, Nagy RD: Sex differences in the myocardial inflammatory response to acute injury. Shock. 2005, 23 (1): 1-10. 10.1097/01.shk.0000148055.12387.15.View ArticlePubMedGoogle Scholar

Copyright

© Wilson et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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