Validation of technetium-99m stannous pyrophosphate myocardial scintigraphy for diagnosing acute myocardial infarction more than 48 hours old when serum creatine kinase-mb has returned to normal

Objectives: Myocardial infarction is the most common form of coronary heart disease, the commonest cause of worldwide mortality. The present biochemical markers take atleast 6 hours for elevation following an episode of myocardial infarction. There is a need for sensitive marker for early diagnosis and prognosis. Lactate, the end product of anaerobic glycolysis is found to be elevated in many critical illnesses. Thus the study was undertaken to assess the levels of serum lactate in patients with myocardial infarction and to correlate it with the frequently used enzymatic markers for the diagnosis of myocardial infarction, i.e creatine kinase – MB and lactate dehydrogenase Methods: Fifty age and sex matched controls and fty cases of myocardial infarction were included in the study. Serum creatine kinase – MB, lactate dehydrogenase and lactate were estimated in these subjects. Results:The serum lactate levels were signicantly higher among cases when compared to controls. The serum lactate levels positively correlated with serum creatine kinase – MB among cases but not with lactate dehydrogenase. Conclusions: We conclude that serum lactate is altered in patients with myocardial infarction and may be considered as a prognostic risk factor in these patients. Further studies are needed to nd the cut-off value of serum lactate for assistance in the hemodynamic management of these patients.

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Improved column method for separating lactate dehydrogenase isoenzymes 1 and 2.

Clinical Chemistry ◽

10.1093/clinchem/24.3.480 ◽

1978 ◽

Vol 24 (3) ◽

pp. 480-482 ◽

Cited By ~ 9

Author(s):

D W Mercer

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Heart Disease ◽

Lactate Dehydrogenase ◽

Sodium Chloride ◽

Lactate Dehydrogenase Activity ◽

Column Method ◽

Creatine Kinase Mb ◽

Lactate Dehydrogenase Isoenzymes

Abstract Lactate dehydrogenase (LD) isoenzymes 1 and 2 in human serum were separated on a column of diethylaminoethyl-Sephadex. Samples layered on mini-columns were eluted with buffered sodium chloride (100, 150, and 200 mmol/liter). Lactate dehydrogenase activity in column effluents was measured by the Wacker method, and their isoenzyme content was evaluated by electrophoresis on polyacrylamide gel. Results for column-fractionated LD-1 and LD-2 were expressed in two ways: LD-1/LD-2 ratios and total LD-1 + LD-2 activities. The former is a more specific indicator of myocardial infarction than the latter. Sera from 10 patients with acute myocardial infarction (increased creatine kinease isoenzyme MB activity) exhibited ratios in the range of 0.92 to 1.56, ratios for 10 patients without heart disease (normal creatine kinase MB) ranged from 0.33 to 0.69.

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Creatine kinase-MB fraction and cardiac troponin T to diagnose acute myocardial infarction after cardiopulmonary resuscitation

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(96)00316-6 ◽

1996 ◽

Vol 28 (5) ◽

pp. 1220-1225 ◽

Cited By ~ 44

Author(s):

Marcus Müllner ◽

Michael M. Hirschl ◽

Harald Herkner ◽

Fritz Sterz ◽

Thomas Leitha ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Cardiopulmonary Resuscitation ◽

Cardiac Troponin ◽

Troponin T ◽

Cardiac Troponin T ◽

Creatine Kinase Mb

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Biochemical Markers of Myocardial Injury Test Turnaround Time: A College of American Pathologists Q-Probes Study of 7020 Troponin and 4368 Creatine Kinase–MB Determinations in 159 Institutions

Archives of Pathology & Laboratory Medicine ◽

10.5858/2004-128-158-bmomit ◽

2004 ◽

Vol 128 (2) ◽

pp. 158-164 ◽

Cited By ~ 2

Author(s):

David A. Novis ◽

Bruce A. Jones ◽

Jane C. Dale ◽

Molly K. Walsh

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Biochemical Markers ◽

Myocardial Injury ◽

Turnaround Time ◽

Test Results ◽

Cardiac Marker ◽

Laboratory Personnel ◽

Creatine Kinase Mb

Abstract Context.—Rapid diagnosis of acute myocardial infarction in patients presenting to emergency departments (EDs) with chest pain may determine the types, and predict the outcomes of, the therapy those patients receive. The amount of time consumed in establishing diagnoses of acute myocardial infarction may depend in part on that consumed in the generation of the blood test results measuring myocardial injury. Objective.—To determine the normative rates of turnaround time (TAT) for biochemical markers of myocardial injury and to examine hospital and laboratory practices associated with faster TATs. Design.—Laboratory personnel in institutions enrolled in the College of American Pathologists Q-Probes Program measured the order-to-report TATs for serum creatine kinase–MB and/or serum troponin (I or T) for patients presenting to their hospital EDs with symptoms of acute myocardial infarction. Laboratory personnel also completed detailed questionnaires characterizing their laboratories' and hospitals' practices related to testing for biochemical markers of myocardial injury. ED physicians completed questionnaires indicating their satisfaction with testing for biochemical markers of myocardial injury in their hospitals. Setting.—A total of 159 hospitals, predominantly located in the United States, participating in the College of American Pathologists Q-Probes Program. Results.—Most (82%) laboratory participants indicated that they believed a reasonable order-to-report TATs for biochemical markers of myocardial injury to be 60 minutes or less. Most (75%) of the 1352 ED physicians who completed satisfaction questionnaires believed that the results of tests measuring myocardial injury should be reported back to them in 45 minutes or less, measured from the time that they ordered those tests. Participants submitted TAT data for 7020 troponin and 4368 creatine kinase–MB determinations. On average, they reported 90% of myocardial injury marker results in slightly more than 90 minutes measured from the time that those tests were ordered. Among the fastest performing 25% of participants (75th percentile and above), median order-to-report troponin and creatine kinase–MB TATs were equal to 50 and 48.3 minutes or less, respectively. Shorter troponin TATs were associated with performing cardiac marker studies in EDs or other peripheral laboratories compared to (1) performing tests in central hospital laboratories, and (2) having cardiac marker specimens obtained by laboratory rather than by nonlaboratory personnel. Conclusion.—The TAT expectations of the ED physicians using the results of laboratory tests measuring myocardial injury exceed those of the laboratory personnel providing the results of those tests. The actual TATs of myocardial injury testing meet the expectations of neither the providers of those tests nor the users of those test results. Improving TAT performance will require that the providers and users of laboratory services work together to develop standards that meet the needs of the medical staff and that are reasonably achievable by laboratory personnel.

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Diagnostic efficacy of a new enzyme immunoassay for creatine kinase MB isoenzyme.

Clinical Chemistry ◽

10.1093/clinchem/30.8.1399 ◽

1984 ◽

Vol 30 (8) ◽

pp. 1399-1401 ◽

Cited By ~ 4

Author(s):

J J Fenton ◽

S Brunstetter ◽

W C Gordon ◽

D F Rippe ◽

M L Bell

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Enzyme Immunoassay ◽

Solid Phase ◽

Correct Diagnosis ◽

Diagnostic Efficacy ◽

Creatine Kinase Mb ◽

Sandwich Type ◽

Sensitivity Specificity

Abstract A new commercial enzyme immunoassay kit for quantification of creatine kinase-MB (CK-MB) isoenzyme was compared with its electrophoretic determination with respect to efficacy in diagnosis of acute myocardial infarction. Enzygnost CK-MB (Behring Diagnostics) is a solid-phase "sandwich"-type enzyme immunoassay with antibodies to the B-subunit coated on plastic tubes and peroxidase-conjugated antibodies to the M-subunit added after incubation with sample. This kit is designed to measure only CK-MB and not CK-MM, CK-BB, adenylate kinase, or atypical CK molecules. The linear-regression equation comparing the two methods was: Enzygnost = 0.98 . electrophoresis - 0.72, with a correlation coefficient of r = 0.967 (n = 143). For 51 patients admitted for diagnosis of possible acute myocardial infarction, the Enzygnost kit achieved 100% sensitivity, specificity, and efficiency in predicting the correct diagnosis. Corresponding values for the electrophoretic assay were: 95.5% sensitivity, 93.1% specificity, and 94.1% efficiency. We conclude that this kit method provides an excellent alternative to electrophoresis.

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Characteristics of creatine kinase-MB and MB isoforms in serum after reperfusion in acute myocardial infarction.

Clinical Chemistry ◽

10.1093/clinchem/35.11.2179 ◽

1989 ◽

Vol 35 (11) ◽

pp. 2179-2185 ◽

Cited By ~ 30

Author(s):

R H Christenson ◽

E M Ohman ◽

P Clemmensen ◽

P Grande ◽

J Toffaletti ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Coronary Flow ◽

Myocardial Reperfusion ◽

Noninvasive Detection ◽

Study Group ◽

Creatine Kinase Mb ◽

Significant Difference ◽

Infarct Related Artery

Abstract Characteristics of CK-MB, the MB1 and MB2 isoforms, and the MB2/MB1 ratio are described in six acute myocardial infarction (AMI) patients in whom the infarct-related artery was identified and, after intervention, normal coronary flow was re-established. After myocardial reperfusion, washout of CK-MB and the MB2 isoform occurred in parallel, with CK-MB peaking between 5.75 and 10.0 h, and MB2 peaking between 4.50 and 8.00 h. In five of the six patients, MB1 peaked between 8.75 and 15.5 h; the MB2/MB1 ratio demonstrated the earliest peak from 0.75 to 2.25 h. When we compared this study group to an additional 10 AMI patients who had achieved myocardial reperfusion earlier, we found a significant difference (P less than 0.005) for all tests, except MB1 isoform activity, as early as 50 min after reperfusion. This same comparison, by logistic-regression analysis, showed that the MB2/MB1 ratio discriminated between the groups 50 min after reperfusion (P less than 0.05); MB2 showed near-significance at 100 min (P less than 0.057); and CK-MB achieved significance after 200 min (P less than 0.05). CK-MB, the MB2 isoform, and especially the MB2/MB1 ratio show potential for the early, noninvasive detection of myocardial reperfusion.

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Comparable detection of acute myocardial infarction by creatine kinase MB isoenzyme and cardiac troponin I

Clinical Chemistry ◽

10.1093/clinchem/40.7.1291 ◽

1994 ◽

Vol 40 (7) ◽

pp. 1291-1295 ◽

Cited By ~ 197

Author(s):

J E Adams ◽

K B Schechtman ◽

Y Landt ◽

J H Ladenson ◽

A S Jaffe

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Cardiac Troponin ◽

Troponin I ◽

Characteristic Curve ◽

Cardiac Injury ◽

Cardiac Troponin I ◽

Creatine Kinase Mb ◽

Coronary Care

Abstract Although measurement of cardiac troponin I (cTnI) is, in some situations, more specific for detection of cardiac injury than is measurement of the MB isoenzyme of creatine kinase (MBCK), its sensitivity and specificity relative to MBCK for detection of myocardial infarction has not been established. Accordingly, we studied prospectively 199 consecutive patients admitted to the coronary care unit. Values of MBCK and cTnI mass were determined in all samples. Of the 188 patients admitted with a suspicion of acute myocardial ischemia, 89 were diagnosed as having an acute myocardial infarction on the basis of the patterns of MBCK values. Eighty-six of these patients also had increased cTnI (concordance, 96.6%); three did not. Of the patients diagnosed as without infarction, five with unstable angina and symptoms in the day(s) prior to admission had increased cTnI, for a cTnI specificity of 94.9%. Receiver operating characteristic curve analysis indicated that cTnI and MBCK had statistically indistinguishable diagnostic accuracies for the detection of acute myocardial infarction.

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