Creatine Kinase MB Isoforms in Patients with Skeletal Muscle Injury: Ramifications for Early Detection of Acute Myocardial Infarction

1992 ◽  
Vol 38 (12) ◽  
pp. 2396-2400 ◽  
Author(s):  
A H Wu ◽  
X M Wang ◽  
T G Gornet ◽  
J Ordóñez-Llanos
Keyword(s):  
Myocardial Infarction ◽  
Skeletal Muscle ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Muscle Injury ◽  
Skeletal Muscle Injury ◽  
Relative Index ◽  
Muscle Trauma ◽  
Normal Individuals

Abstract We measured total creatine kinase (CK), CK-MB isoenzyme, and the MB isoforms in 202 serum and plasma samples from nine groups of patients and normal individuals: 39 with acute myocardial infarction (MI), divided according to time between the onset of chest pain and blood collection (1-6 h, 7-12 h, and 13-48 h); 26 with chest pain for whom an MI was ruled out, sampled at admission; 17 undergoing bypass surgery or cardiac catheterization, sampled within 6 h after either procedure; 17 with acute skeletal muscle injury, sampled within 8 h after injury; 30 marathon runners immediately after a race; 17 runners and other athletes > 12 h after training or a race; 12 with cerebral injury or seizures, sampled at admission; 8 with closed head injury, sampled at admission; and 38 normal subjects. CK-MB (relative index) and MB isoforms (MB2/MB1) were respectively increased in 15% and 75% of MI patients 1-6 h after onset, 94% and 94% after 7-12 h, and 88% and 8% after 12 h, and in 87% and 82% of cardiac surgery patients. MB isoforms were increased in most patients with acute skeletal muscle trauma and in subjects examined after exercise, but were within normal limits in patients for whom MI was ruled out, patients with cerebral trauma, and normal individuals. The relative index of MB/total CK was normal in essentially all individuals in the last groups, including those with acute skeletal muscle trauma. We concluded that the CK-MB isoform ratio is increased in both acute skeletal muscle injury and MI. The isoform ratio is most useful for distinguishing recent from old (> 12 h) injury.

Creatine kinase MB in cases of skeletal muscle trauma.

1988 ◽  
Vol 34 (5) ◽  
pp. 898-901 ◽  
Author(s):  
J G Schwartz ◽  
T J Prihoda ◽  
J H Stuckey ◽  
C L Gage ◽  
M L Darnell
Keyword(s):  
Skeletal Muscle ◽  
Creatine Kinase ◽  
Muscle Injury ◽  
Myocardial Injury ◽  
Skeletal Muscle Injury ◽  
Negative Results ◽  
Muscle Trauma ◽  
Creatine Kinase Mb ◽  
Cardiac Status ◽  
Creatine Kinase Isoenzyme Mb

Abstract Fifty-eight patients admitted through our emergency room with severe skeletal muscle injury but no obvious cardiac contusions were evaluated for creatine kinase isoenzyme MB (CK-MB). When such patients show an above-normal value for total CK, it is a question of whether or not myocardial injury has been sustained along with skeletal muscle injury when (a) there are no obvious chest contusions or (b) the patient is unconscious and unable to complain of chest pain. Whenever there is doubt concerning the cardiac status of a patient, lactate dehydrogenase (LD) isoenzymes, serial electrocardiograms, and CK isoenzymes are ordered. Our study revealed that serum of 8.6% of the trauma victims had CK-MB values exceeding 5.0 EU/L (reflecting abnormal CK-MB concentrations) as part of their increased total CK. All patients had normal electrocardiographic patterns along with negative results for LD isoenzymes; none had sustained any demonstrable myocardial injury. The CK-MB value must be interpreted together with the total CK value for appropriate diagnosis in patients with skeletal muscle trauma.

The Importance of Creatine Kinase Determination in Identifying Acute Myocardial Infarction among Patients Complaining of Chest Pain in an Emergency Room

Cardiology ◽  
1987 ◽  
Vol 74 (2) ◽  
pp. 100-110 ◽  
Author(s):  
Sami Viskin ◽  
Karin Heller ◽  
David Gheva ◽  
Avi Hassner ◽  
Itzhak Shapira ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Emergency Room

Creatine kinase radioimmunoassay and isoenzyme electrophoresis compared in the diagnosis of acute myocardial infarction.

1980 ◽  
Vol 26 (7) ◽  
pp. 861-866 ◽  
Author(s):  
H A Homburger ◽  
G L Jacob
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Predictive Value ◽  
Positive Test ◽  
Test Results ◽  
Diagnostic Specificity ◽  
B Subunit ◽  
Creatine Kinase B

Abstract We compared, in 116 patients, the relative usefulness of results of tests for creatine kinase B isoenzymes, as measured by radioimmunoassay, and the MB isoenzyme, as measured by electrophoresis, in diagnosis of acute myocardial infarction. The radioimmunoassay was specific for isoenzymes of creatine kinase containing the B subunit. All patients with acute transmural infarcts had positive test results by both techniques, but concentrations of B-isoenzymes were more frequently above normal than were MB bands in the case of patients with acute subendocardial infarcts and in the case of all patients with acute myocardial infarcts from whom sera were collected more than 24 h after onset of chest pain. Concentrations of B-isoenzymes also were increased, even when MB bands were not electrophoretically detectable, in specimens from several patients without documented actue myocardial infarcts. These abnormal results presumably were caused by increased concentrations of the BB isoenzyme in serum. Accordingly, an increased concentration of B-isoenzymes had less diagnostic specificity and predictive value for acute myocardial infarction than did a detectable MB band. Results of isoenzyme electrophoresis were more reliable for establishing this diagnosis, but the results of radioimmunoassay were more reliable for excluding it in patients with chest pain as the primary symptom.

Cardiac Troponin I and T Concentrations in Patients with Cocaine-Associated Chest Pain

1996 ◽  
Vol 33 (3) ◽  
pp. 183-186 ◽  
Author(s):  
Mary McLaurin ◽  
Fred S Apple ◽  
Timothy D Henry ◽  
Scott W Sharkey
Keyword(s):  
Skeletal Muscle ◽  
Chest Pain ◽  
Cardiac Troponin ◽  
Muscle Injury ◽  
Troponin I ◽  
Troponin T ◽  
Acute Chest Pain ◽  
Cardiac Troponin I ◽  
Skeletal Muscle Injury ◽  
Rule Out

Patients with cocaine-related chest pain with electrocardiographic (ECG) abnormalities are often admitted to rule out acute myocardial infarction (AMI). Cardiac troponin I and T should be superior to measurement of creatine kinase (CK)—MB for detecting cardiac injury in patients with coexisting skeletal muscle injury. We prospectively evaluated 19 consecutive patients with acute chest pain related to cocaine use who were hospitalized to rule out AMI. The admission ECG was abnormal in 16 of 19 patients. Total CK and CK—MB were elevated during the hospital course in 14 and 3 patients, respectively. Cardiac troponin I and cardiac troponin T levels were within normal limits in all patients demonstrating that recent myocardial injury did not occur. Clinically, no patient had an AMI. Cocaine-induced thoracic skeletal muscle injury or transient cocaine-induced coronary vasospasm should be considered as alternative sources of chest pain in these patients.

Activity of serum aspartate aminotransferase isoenzymes in patients with acute myocardial infarction.

1987 ◽  
Vol 33 (1) ◽  
pp. 67-71 ◽  
Author(s):  
M Panteghini ◽  
F Pagani ◽  
C Cuccia
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Aspartate Aminotransferase ◽  
Biological Information ◽  
Serum Samples ◽  
The Third ◽  
Serum Aspartate Aminotransferase ◽  
Serial Serum

Abstract Activities of aspartate aminotransferase (AST) isoenzymes were determined in serial serum samples from 40 cases of acute myocardial infarction, and compared with activities of creatine kinase, CK-MB isoenzyme, lactate dehydrogenase, and alpha-hydroxybutyrate dehydrogenase for temporal changes. Cytosolic (soluble) AST (s-AST) and mitochondrial AST (m-AST) respectively increased 6.6 and 9.0 h after onset of chest pain. The median time at which serum m-AST activity peaked (15.8 U/L, range 6.4-53.5 U/L) was 47.8 h after the onset of infarction, 19.8 h later than the peak s-AST activity (171 U/L, range 53-517 U/L) and m-AST also disappeared from the serum more slowly than s-AST (p less than 0.001). Serum m-AST values were above normal for at least six days after the infarct. The ratio of m-AST to total AST in serum increased after myocardial infarction, being greatest (20%, range 11-32%) on the third day after onset. For individuals, peak activities of s-AST correlated well with total CK (r = 0.91) and CK-MB (r = 0.86) peak activities, indicating that s-AST also reflects the infarct size. However, m-AST correlated poorly with the enzymes commonly used in infarct diagnosis; it apparently provides different biological information.

Creatine kinase:aspartate aminotransferase activity ratio as an indicator of the source of an increased creatine kinase activity.

1988 ◽  
Vol 34 (12) ◽  
pp. 2506-2510 ◽  
Author(s):  
D R Dufour
Keyword(s):  
Myocardial Infarction ◽  
Skeletal Muscle ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Retrospective Study ◽  
Kinase Activity ◽  
Activity Ratio ◽  
Creatine Kinase Activity ◽  
Aminotransferase Activity ◽  
Creatine Kinase Isoenzyme

Abstract Although measurements of creatine kinase isoenzyme 2 (CK-MB) are often used to diagnose acute myocardial infarction, their sensitivity and specificity are less than 100%. Because skeletal muscle contains more CK and less aspartate aminotransferase (AST) than cardiac muscle, the CK/AST ratio might provide a useful adjunct in evaluating the source of a supranormal value for CK. I established the following decision levels in a retrospective study of 342 patients: ratios less than 14 (if total CK was 300-1200 U/L), less than 20 (CK 1201-2000 U/L), or less than 25 (CK greater than 2000 U/L) suggested myocardial infarction, with a sensitivity of 95% and a specificity of 65%. In a validation study with 277 additional patients, liver disease and alcohol abuse caused erroneous results, leading to exclusion of 22% of these patients. In the remaining cases, sensitivity was 94%, specificity 90%. The CK/AST ratios changed little with time, suggesting that a single value would be adequate for evaluating patients with increased CK.

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