Critical difference between serial measurements of CK-MB mass to detect myocardial damage

Abstract To assess the critical difference in serial measurements of CK-MBmass and the ability of this critical difference to detect myocardial damage, we studied 110 patients in whom an acute myocardial infarction (AMI) had been ruled out. Blood samples were drawn at 3, 4, 5, 6, 7, 8, 12, 16, 20, and 24 h after onset of symptoms. With a critical difference of 72.6%, an increase of >2.0 μg/L between two CK-MBmass measurements was determined to be significant. Twenty-three of the non-AMI patients had an increase in CK-MBmass >2.0 μg/L, but five of these did not have an abnormal concentration of troponin T (i.e., not >0.1 μg/L). Also among the 110 non-AMI patients, 22 did have an abnormal troponin T value, 18 of whom (82%) also had CK-MBmassincreased by >2.0 μg/L. In 20 of the 23 patients with an increase in CK-MBmass >2.0 μg/L, this increase was detected from the values for two samples collected at 5 and 12 h after onset of symptoms. In conclusion, using the critical difference for CK-MBmassdefined as an increase >2.0 μg/L detected myocardial damage in patients without AMI.

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Interpretation of high sensitive troponin assays: acute or chronic myocardial damage?

Orvosi Hetilap ◽

10.1556/oh.2011.29202 ◽

2011 ◽

Vol 152 (38) ◽

pp. 1528-1534 ◽

Cited By ~ 1

Author(s):

Eszter Szánthó ◽

Zoltán Szabó ◽

József Varga ◽

György Paragh ◽

Anna V. Oláh

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Troponin I ◽

Troponin T ◽

Troponin Level ◽

Cardiac Damage ◽

Creatine Kinase Mb ◽

Two Samples ◽

High Sensitive Troponin

Troponin is the first choice in the diagnosis of acute myocardial infarction. Correct interpretation is challenging, because high sensitive troponin tests used today detect even the smallest cardiac damage. Methods: High sensitive troponin T (Roche) and troponin I (Mitsubishi Pathfast) and creatine-kinase activity were measured in 20 patients, each having two samples with the time lapse 3–9 hours. Results: In the group without acute myocardial infarction (n = 10) no significant increase in creatine-kinase and creatine-kinase-MB levels were seen, and the mild raise of troponins was due to other cardiovascular problems (atrial fibrillation, paroxysmal supraventricular tachycardia). With acute myocardial infarction (n = 10) a dramatic increase of troponin levels was found in the second samples, and also an increase of creatine-kinase and creatine-kinase-MB activity. According to Fischer-probe a twofold or higher increase of troponin implies 19-times higher risk of acute myocardial infarction in the case of troponin T and 8-times odds ratio at troponin I. Conclusions: The patient’s accompanying diseases should always be considered. If the troponin level is elevated, the measurement should be repeated within 3–6 hours. When troponin shows at least a twofold increase and the patient has chest pain or positive ECG, AMI is likely, and the patient needs special medical care. Although the first troponin level might be elevated if accompanying diseases cause chronic cardiac damage, it can be differentiated by a second troponin measurement. Orv. Hetil., 2011, 152, 1528–1534.

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Recommended standards for biochemical markers of myocardial damage: All Wales Clinical Biochemistry Audit Group

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1258/0004563054890042 ◽

2005 ◽

Vol 42 (5) ◽

pp. 346-350 ◽

Cited By ~ 2

Author(s):

EJ Williams ◽

CJH Jones ◽

IFW McDowell ◽

JA Tovey ◽

MA Thomas ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Biochemistry ◽

Troponin T ◽

Myocardial Damage ◽

Extensive Discussion ◽

Reference Limit ◽

Two Samples ◽

Coronary Syndromes ◽

Line Test ◽

Effective Use

The effective use of cardiac-specific troponin estimations in the diagnosis of acute myocardial infarction (AMI) is clouded by the imprecise definition surrounding the decision limits. This has led to a wide variation of criteria for the diagnosis of myocardial infarction. A survey of troponin measurements in Welsh laboratories, undertaken in 2003 under the auspices of the All Wales Clinical Biochemistry Audit Group, revealed significant variations in laboratory and clinical practice. Extensive discussion and consultation led by a working group of clinical biochemists and cardiologists in Wales culminated in recommendations concerning the use of troponin assays to establish myocardial damage. The key recommendations are: •Cardiac troponin (T or I) should be the first-line test for myocardial damage; •Two samples should be collected, at admission and 12-24 h later. The first sample is used for 'rule in' purposes, but not to 'rule out' myocardial damage; •Only one threshold (cut-off) value for troponin should be quoted on laboratory reports, values above which are indicative of myocardial damage. A study by the Wales External Quality Assurance Scheme (WEQAS) enabled the derivation of the recommended cut-off concentrations of troponin for defining myocardial damage, defined for each assay as the concentration that can be reliably distinguished, with a confidence interval of 99%, from the 99th percentile reference limit. These recommended standards provide a rationale for a uniform approach for troponin assays for patients with chest pain, working towards a standardized approach to the diagnosis and management of patients presenting with acute coronary syndromes.

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Evaluation of Adjuvant Biomarkers in Acute Myocardial Infarction

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol03-i02/04 ◽

2018 ◽

Vol 3 (02) ◽

Author(s):

Varghese M. V ◽

Gaikwad S. B ◽

Fawade M. M. ◽

Bhattacharya M. A.

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Serum Sodium ◽

Extracellular Enzymes ◽

Troponin T ◽

Myocardial Damage ◽

Cost Effective ◽

Control Group ◽

Cardiac Markers ◽

Time Saving

Background: Acute myocardial infarction (AMI) is one of the dreadful complications of cardiovascular disease causing increasing mortality worldwide. The alterations (increase or decrease) of intracellular and extracellular enzymes or components in developing phase of disease are called markers. Variations in biochemical markers like Cardiac Troponins - T (ctnl) creatine kinase may correlate with the extent of myocardial damage in Acute myocardial infarction (AMI). Aim and Objectives: This study was undertaken to evaluate serum sodium, potassium, urea and creatinine as adjunctive parameters along with cardiac markers, which probably help in better prognosis of AMI. Material Methods: 100 subjects were included in this study with confirmed diagnosis of recent AMI by the physicians and 100 healthy persons visiting hospital for routine checkup. Blood samples of both group were analyzed for serum urea by Diacetylmonoxime, creatinine by Jaffe's, &sodium & potassium by flamephotometry uing Bio- Lab Diagnostic Kit Methods. Whereas cardiac troponin - T was done by chemiluminescence immunoassay (CLIA) on Lumax hormone analyser and CKMB by kinetic kit method. Results: There were statistically significant decreased levels of serum sodium (P<0.0001) potassium (p<0.0001), and elevated levels of urea (p<0.0001) and creatinine (0.0001) observed in AMI. Both established cardiac markers Trop- T and CKMB were extremely statistically significantly increased (p<0.0001) as compared to control group. Conclusion: This study showed association of routine blood tests such as urea, creatinine, sodiumand potassium hence can be used as supplement information with regard to treatment and better prognosis of AMI patients or these could be cost effective time saving adjuvant markers in management of myocardial infarction.

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Serial measurements of cardiac markers to rule in or out acute myocardial damage less than 3 h after admission in acute chest pain patients without ECG-signs of acute myocardial infarction

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.1080/00365519850186517 ◽

1998 ◽

Vol 58 (4) ◽

pp. 331-338

Author(s):

M Stokke ◽

T Grønvold ◽

A M Siebke ◽

ø Skjæggestad ◽

J H Strømme

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Acute Chest Pain ◽

Myocardial Damage ◽

Cardiac Markers ◽

Pain Patients ◽

Serial Measurements

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Systemic Thrombin Generation and Activity Resistant to Low Molecular Weight Heparin Administered Prior to Streptokinase in Patients with Acute Myocardial Infarction

Thrombosis and Haemostasis ◽

10.1055/s-0038-1655907 ◽

1997 ◽

Vol 77 (01) ◽

pp. 057-061 ◽

Cited By ~ 7

Author(s):

Dennis W T Nilsen ◽

Lasse Gøransson ◽

Alf-Inge Larsen ◽

Øyvind Hetland ◽

Peter Kierulf

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Molecular Weight ◽

Body Weight ◽

Low Molecular Weight Heparin ◽

Troponin T ◽

Bleeding Complications ◽

Control Group ◽

Low Molecular Weight ◽

Creatine Kinase Mb

SummaryOne hundred patients were included in a randomized open trial to assess the systemic factor Xa (FXa) and thrombin inhibitory effect as well as the safety profile of low molecular weight heparin (LMWH) given subcutaneously in conjunction with streptokinase (SK) in patients with acute myocardial infarction (MI). The treatment was initiated prior to SK, followed by repeated injections every 12 h for 7 days, using a dose of 150 anti-Xa units per kg body weight. The control group received unfractionated heparin (UFH) 12,500 IU subcutaneously every 12 h for 7 days, initiated 4 h after start of SK infusion. All patients received acetylsalicylic acid (ASA) initiated prior to SK.Serial blood samples were collected prior to and during the first 24 h after initiation of SK infusion for determination of prothrombin fragment 1+2 (Fl+2), thrombin-antithrombin III (TAT) complexes, fibrinopeptide A (FPA) and cardiac enzymes. Bleeding complications and adverse events were carefully accounted for.Infarct characteristics, as judged by creatine kinase MB isoenzyme (CK-MB) and cardiac troponin T (cTnT), were similar in both groups of patients.A comparable transient increase in Fl+2, TAT and FPA was noted irrespective of heparin regimen. Increased anti-Xa activity in patients given LMWH prior to thrombolytic treatment had no impact on indices of systemic thrombin activation.The incidence of major bleedings was significantly higher in patients receiving LMWH as compared to patients receiving UFH. However, the occurrence of bleedings was modified after reduction of the initial LMWH dose to 100 anti-Xa units per kg body weight.In conclusion, systemic FXa- and thrombin activity following SK-infusion in patients with acute MI was uninfluenced by conjunctive LMWH treatment.

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Use of Circulating MicroRNAs to Diagnose Acute Myocardial Infarction

Clinical Chemistry ◽

10.1373/clinchem.2011.173823 ◽

2012 ◽

Vol 58 (3) ◽

pp. 559-567 ◽

Cited By ~ 160

Author(s):

Yvan Devaux ◽

Mélanie Vausort ◽

Emeline Goretti ◽

Petr V Nazarov ◽

Francisco Azuaje ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Troponin T ◽

Correct Diagnosis ◽

Patient Treatment ◽

Healthy Controls ◽

Clinical Model ◽

Acute Mi ◽

St Elevation

Abstract BACKGROUND Rapid and correct diagnosis of acute myocardial infarction (MI) has an important impact on patient treatment and prognosis. We compared the diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) and cardiac enriched microRNAs (miRNAs) in patients with MI. METHODS Circulating concentrations of cardiac-enriched miR-208b and miR-499 were measured by quantitative PCR in a case-control study of 510 MI patients referred for primary mechanical reperfusion and 87 healthy controls. RESULTS miRNA-208b and miR-499 were highly increased in MI patients (>105-fold, P < 0.001) and nearly undetectable in healthy controls. Patients with ST-elevation MI (n= 397) had higher miRNA concentrations than patients with non–ST-elevation MI (n = 113) (P < 0.001). Both miRNAs correlated with peak concentrations of creatine kinase and cTnT (P < 10−9). miRNAs and hs-cTnT were already detectable in the plasma 1 h after onset of chest pain. In patients who presented <3 h after onset of pain, miR-499 was positive in 93% of patients and hs-cTnT in 88% of patients (P= 0.78). Overall, miR-499 and hs-cTnT provided comparable diagnostic value with areas under the ROC curves of 0.97. The reclassification index of miR-499 to a clinical model including several risk factors and hs-cTnT was not significant (P = 0.15). CONCLUSION Circulating miRNAs are powerful markers of acute MI. Their usefulness in the establishment of a rapid and accurate diagnosis of acute MI remains to be determined in unselected populations of patients with acute chest pain.

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