Diagnostic evaluation of creatine kinase-2 mass and creatine kinase-3 and -2 isoform ratios in early diagnosis of acute myocardial infarction

Abstract The diagnostic efficacy of creatine kinase (CK) isoforms (CK-3 and CK-2) was compared with measurement of CK-2 mass concentrations for the early diagnosis of myocardial infarction (MI). Serial serum samples drawn from 76 patients with confirmed MI and 55 non-MI patients were used for determining CK-2 mass concentrations and the MM3/MM1 (CK-3 isoforms) and MB2/MB1 (CK-2 isoforms) ratios. We compared the diagnostic utility of each by receiver-operating-characteristic (ROC) curve and likelihood ratio analyses. Our results indicate that all three tests were ineffective within the first 4 h after the onset of chest pain. All three were most effective at 4-18 h after onset, but both CK-3 and CK-2 isoform ratios were less effective than CK-2 mass concentrations in the next 6-h period (18-24 h). In the critical time between 3 and 6 h, the diagnostic performance of all three was comparable.

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

Clinical Chemistry ◽

10.1093/clinchem/33.1.67 ◽

1987 ◽

Vol 33 (1) ◽

pp. 67-71 ◽

Cited By ~ 10

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.

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Role of rapid immunoassays for urgent ("stat") determinations of creatine kinase isoenyme MB.

Clinical Chemistry ◽

10.1093/clinchem/35.8.1752 ◽

1989 ◽

Vol 35 (8) ◽

pp. 1752-1756 ◽

Cited By ~ 30

Author(s):

A H Wu ◽

T G Gornet ◽

C C Harker ◽

H L Chen

Keyword(s):

Myocardial Infarction ◽

Creatine Kinase ◽

Early Diagnosis ◽

Artery Bypass ◽

Performance Criteria ◽

Analytical Sensitivity ◽

Serum Samples ◽

Assay Performance ◽

Sample Stability

Abstract We compared the analytical performance of three immunoassays used to rapidly determine creatine kinase (EC 2.7.3.2; CK) isoenzyme MB in serum: Dade's "Stratus," Corning's "Magic Lite," and Hybritech's "Icon QSR CK-MB." Performance criteria included precision, analytical sensitivity, sample stability, and analytical and clinical correlation of results for serum samples taken from healthy individuals, patients with suspected and confirmed acute myocardial infarction, and patients after coronary artery bypass surgery. We also examined 31 samples taken from patients in the emergency room suspected of myocardial infarction, to evaluate the potential of these assays for early diagnosis. Although these assays differ in the manner in which CK-MB is measured, and therefore have different procedural requirements, we conclude that they are equivalent in overall assay performance. None of these assays, however, is sufficiently sensitive for early diagnosis of myocardial infarction; therefore, results cannot be used by cardiologists in deciding whether acute thrombolytic therapy should be given. Other management decisions, such as the optimal utilization of intensive-care bed space, may justify using these assays on a "stat" basis.

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Analytical and Clinical Evaluation of Creatine Kinase MB Mass Assay by IMx: Comparison with MB Isoenzyme Activity and Serum Myoglobin for Early Diagnosis of Myocardial Infarction

Clinical Chemistry ◽

10.1093/clinchem/38.12.2380 ◽

1992 ◽

Vol 38 (12) ◽

pp. 2380-2386 ◽

Cited By ~ 22

Author(s):

M Van Blerk ◽

V Maes ◽

L Huyghens ◽

M P Derde ◽

R Meert ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Early Diagnosis ◽

Predictive Value ◽

Diagnostic Performance ◽

Creatine Kinase Mb ◽

Sensitivity Specificity ◽

Serum Myoglobin

Abstract We analytically and clinically evaluated Abbott's IMx assay for creatine kinase (CK) isoenzyme MB (CK-MB) in serum. Over a 1-year period, the method was more specific but less precise than catalytic isoenzyme measurements by electrophoresis or immunoinhibition. Sera from different individuals without electrophoretic evidence of CK-MB but containing macro CK type 1 (n = 20), mitochondrial CK (n = 5), or CK-BB (n = 5) were scored as CK-MB negative by the IMx. Likewise, CK-MB-negative by the sera remained so after addition of purified human CK-MM (< or = 7600 U/L) or CK-BB (< or = 8100 U/L). For 39 patients admitted for suspicion of uncomplicated acute myocardial infarction (precordial pain for < or = 4 h), the diagnostic performance of the IMx CK-MB assay on admission and 4 h later was superior to that of total CK activity and compared well with that of CK-MB activity measured by electrophoresis or immunoinhibition. An admission, myoglobin showed a higher diagnostic sensitivity, specificity, and predictive value than did CK-MB and was the most informative test. Diagnostic performance on admission and 4 h later was further improved by considering positivity for myoglobin and for CK-MB by IMx and for the change in each over the first 4 h of hospitalization as criteria. Twelve hours after admission, diagnostic performance was further improved for all CK and CK-MB methods but began to decline for myoglobin.

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Application of the Regression Coefficient to Timed Serial Serum Creatine Kinase Measurements in the Early Diagnosis of Myocardial Infarction

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456328902600619 ◽

1989 ◽

Vol 26 (6) ◽

pp. 558-559 ◽

Cited By ~ 7

Author(s):

G Rutty ◽

Shanta Patel ◽

P O'Gorman

Keyword(s):

Myocardial Infarction ◽

Creatine Kinase ◽

Early Diagnosis ◽

Regression Coefficient ◽

Serum Creatine Kinase ◽

Serial Serum

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The early diagnostic value of combined detection of plasma miR-181b, miR-196a and miR-210 in pancreatic cancer

10.21203/rs.2.15310/v1 ◽

2019 ◽

Author(s):

Gongpan Liu ◽

Cunhua Shao ◽

Anyun Li ◽

Xiaobin Zhang ◽

Xingjun Guo ◽

...

Keyword(s):

Pancreatic Cancer ◽

Early Diagnosis ◽

Operating Characteristic ◽

Clinical Stage ◽

Diagnostic Value ◽

Carbohydrate Antigen ◽

Healthy Individuals ◽

Diagnostic Efficacy ◽

Lymph Nodes Metastasis ◽

Combined Detection

Abstract Background This study aimed to investigate the effect of combination of plasma miR-181b, miR-196a and miR-210 on early diagnosis of pancreatic cancer (PC).Methods In our study, the plasma was isolated from patients with PC and healthy individuals, respectively. The expressions of miR-181b, miR-196a and miR-210 were detected by qRT-PCR. Moreover, the level of carbohydrate antigen 199 (CA199) was measured by electrochemiluminescence (ECL) assay. Furthermore, the area under the receiver operating characteristic (ROC) curve (AUC) was used to analyze the diagnostic efficacy of miR-181b, miR-196a, miR-210 and CA199, as well as the combination of thses miRNAs in early PC patients and healthy individuals.Results The expressions of miR-181b, miR-196a and miR-210 were significantly upregulated in PC patients. In addition, the level of CA199 was also significantly upregulated in the plasma of PC patients. The expressions of miR-181b, miR-196a and miR-210 were closely associated with lymph nodes metastasis, clinical stage and vascular invasion, but had no correlation with the patient's age, gender and tumor size. Moreover, miR-181b, miR-196a and miR-210 have lower AUC than CA199 in PC patients. The combinations miR-181b + miR-196a, miR-181b + miR-210, miR-196a + miR-210 also have lower AUC than CA199 in PC patients. It is worth noting that the combinations miR-181b + miR-196a + miR-210 have higher AUC than CA199 in PC.Conclusions Our study demonstrated that the combination of plasma miR-181b, miR-196a and miR-210 had good value for PC early diagnosis.

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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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Serum Creatine Kinase in the Early Diagnosis of Myocardial Infarction

Proceedings of the Association of Clinical Biochemists ◽

10.1177/036985646700400711 ◽

1967 ◽

Vol 4 (7) ◽

pp. 219-220

Author(s):

A. F. Smith

Keyword(s):

Myocardial Infarction ◽

Creatine Kinase ◽

Early Diagnosis ◽

Serum Creatine Kinase

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Incremental Value of the Leukocyte Differential and the Rapid Creatine Kinase-MB Isoenzyme for the Early Diagnosis of Myocardial Infarction

Annals of Internal Medicine ◽

10.7326/0003-4819-122-5-199503010-00003 ◽

1995 ◽

Vol 122 (5) ◽

pp. 335 ◽

Cited By ~ 69

Author(s):

Stephen P. Thomson

Keyword(s):

Myocardial Infarction ◽

Creatine Kinase ◽

Early Diagnosis ◽

Incremental Value ◽

Creatine Kinase Mb

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Utility of Ischemia Modified Albumin as an Early Marker for Diagnosis of Acute Coronary Syndrome

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i1.19383 ◽

2018 ◽

Vol 16 (1) ◽

pp. 16-21 ◽

Cited By ~ 3

Author(s):

Bijaya Mishra ◽

Sunil Pandey ◽

Surya Raj Niraula ◽

Bijendra Kumar Rai ◽

Prahlad Karki ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Creatine Kinase ◽

Diagnostic Performance ◽

Operating Characteristic ◽

Troponin I ◽

Characteristic Curve ◽

Ischemia Modified Albumin ◽

Coronary Syndrome ◽

Creatine Kinase Mb ◽

St Elevation

Background: The diagnosis of acute coronary syndrome remains challenging, as cardiac troponins and creatine kinase-MB do not detect myocardial ischemia. Ischemia modified albumin is biomarker positive within 6-10 minutes following ischemic onset, where oxygen free radicals leads to reduction in binding capacity of human serum albumin to transitional metal-cobalt. The objective of this study was to compare ischemia modified albumin between acute coronary syndrome patients and healthy controls, and evaluate diagnostic performance of ischemia modified albumin compared to cardiac troponins, creatine kinase-MB and electrocardiogram in acute coronary syndrome patients.Methods: Fifty ACS patients and 50 healthy controls were enrolled in this cross-sectional study. Ischemia modified albumin was measured after addition of known amount of cobalt to human serum albumin, followed by spectrophotometric determination of unbound cobalt fraction at 470 nm using dithiothreitol as coloring agent. Independent student t-test and One-way ANOVA to compare differences of mean between groups; diagnostic sensitivity and specificity of ischemia modified albumin was determined by receiver operating characteristic curve; McNemar-test was used to assess diagnostic performance of entire test parameters, when used alone and in combinations.Results: Ischemia modified albumin was significantly higher in acute coronary syndrome patients compared to controls (0.823±0.191 vs 0.410±0.081)(p<0.001). Receiver operating characteristic curve derived optimal cutoff of 0.475 Absorbance unit had sensitivity and specificity of 92% and 82% respectively (area under curve- 0.96). However, no significant differences in mean ischemia modified albumin values between three categories of acute coronary syndrome were seen. Sensitivity of ischemia modified albumin assay (92%) was significantly higher compared to electrocardiogram (72%), cardiac troponin I (18%), and creatine kinase-MB(42%).Conclusions: Ischemia modified albumin is elevated in acute coronary syndrome patients with better diagnostic performance compared to electrocardiogram, cardiac troponin I, and creatine kinase-MB for early diagnosis, however, with limited ability to discriminate between ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina.

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