scholarly journals Evaluating the use of biomarkers for the diagnosis of myocardial injury in neonates

2021 ◽  
pp. 15-20
Author(s):  
Nikhila Butani ◽  
Tapas Mondal
Keyword(s):  
Myocardial Infarction ◽  
Creatine Kinase ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Sensitivity And Specificity ◽  
Myocardial Injury ◽  
Diagnostic Tools ◽  
Diagnostic Strategies ◽  
Creatine Kinase Mb ◽  
Cardiac Troponins

Myocardial infarction is defined as the obstruction of blood flow to the heart, resulting in oxygen deprivation. While myocardial infarction in adults is common and has sufficient diagnostic strategies, there remain gaps in the diagnostic strategies for myocardial infarction in neonates. Presently, biomarkers such as creatine-kinase MB, brain natriuretic peptide, myoglobin, and troponin are believed to be potential diagnostic tools for neonatal myocardial infarction. This literature review explores the efficacy of biomarkers for early diagnosis of neonatal myocardial infarction. The review concludes that creatine-kinase MB, brain natriuretic peptide, and myoglobin do not serve as accurate biomarkers for myocardial infarction in neonates. However, cardiac troponins, in particular cardiac troponin I, have high sensitivity and specificity for diagnosing myocardial injury. Cardiac troponins experience rapid elevation upon myocardial injury, and they remain unaffected by gestational age and birth weight. In addition, they do not cross the placenta and are therefore intrinsic to the neonate. Future research should be conducted to verify the accuracy, sensitivity, and specificity of cardiac troponins as myocardial infarction biomarkers.  

Effect of statin on perioperative myocardial injury in isolated valve surgery

2020 ◽  
pp. 021849232097451
Author(s):  
Atul Kaushik ◽  
Aditya Kapoor ◽  
Surendra Kumar Agarwal ◽  
Shantanu Pande ◽  
Shiridhar Kashyap ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Cardiopulmonary Bypass ◽  
Brain Natriuretic Peptide ◽  
Valve Replacement ◽  
Natriuretic Peptide ◽  
Myocardial Injury ◽  
Troponin I ◽  
Ischemia Reperfusion ◽  
Area Under The Curve ◽  
Creatine Kinase Mb

Background Statins have known pleiotropic effects that confer protection from ischemia-reperfusion injury. Because cardiopulmonary bypass is a potentially reversible ischemia-reperfusion sequence, we aimed to assess whether statin loading could help to limit myocardial injury in patients undergoing isolated heart valve replacement under cardiopulmonary bypass. Methods One hundred patients with rheumatic valvular heart disease undergoing valve replacement received either a loading dose of rosuvastatin (40 mg initiated 7 days before surgery; loaded group) or no statins (non-loaded group). Cardiac troponin I, creatine kinase MB, and brain natriuretic peptide were measured at 8, 24, and 48 hours postoperatively. The primary endpoint was the extent of perioperative myocardial injury measured by the area under the curve for each biomarker. Results Despite similar baseline levels, all biomarkers at 8, 24, and 48 h were significantly lower in the loaded group. The area under the curve of each biomarker was significantly lower in the loaded group than in the non-loaded group (troponin I: 31.43 vs. 77.21 ng·h·mL−1, creatine kinase MB 309.31 vs. 429.12 ng·h·mL−1, brain natriuretic peptide 5176.11 vs. 16119.31 pg·h·mL−1, all p < 0.001). The mean changes from baseline to peak levels were also significantly lower in the loaded group. The loaded group had a shorter hospital stay but no significant difference was seen in ventilator time, inotrope time, aortic crossclamp time, cardiopulmonary bypass time, or intensive care unit stay. Conclusion In patients undergoing valve replacement, high-dose statin loading before surgery had a favorable impact on the release kinetics of various cardiac biomarkers.

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

2004 ◽  
Vol 128 (2) ◽  
pp. 158-164 ◽  
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.

Clinical evaluation of an immunoinhibition procedure for creatine kinase-MB.

1980 ◽  
Vol 26 (1) ◽  
pp. 150-152
Author(s):  
D Obzansky ◽  
J A Lott
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Sensitivity And Specificity ◽  
Clinical Evaluation ◽  
Creatine Kinase Isoenzyme ◽  
Creatine Kinase Mb ◽  
Diagnostic Sensitivity And Specificity ◽  
Creatine Kinase Isoenzyme Mb

Abstract We have clinically evaluated the Dade "Cardiozyme" immunoinhibition procedure for determination of creatine kinase isoenzyme MB (CK-MG) in 71 patients who were suspected of having had an acute myocardial infarction. Electrophoresis for CK-MB was also carried out. On the basis of diagnostic sensitivity and specificity for myocardial infarction, we found the Dade procedure for CK-MB to be somewhat inferior to electrophoresis. In 11 patients for whom the time of infarction was known, we observed normal CK-MB results for two of them by both immunoinhibition and electrophoresis during the first 24 h, but subsequently could detect abnormal CK-MB results by both methods. Thus in some patients such data are not helpful for making a diagnosis in the first 24 h. The Dade procedure is easy to perform, but lacks sensitivity in the region of low CK-MB activity, requires a very stable spectrophotometer, is imprecise, and produces negative numerical results in patients without myocardial infarction.

Vigorous response in plasma N-terminal pro-brain natriuretic peptide (NT-BNP) to acute myocardial infarction

2004 ◽  
Vol 106 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Denzil GILL ◽  
Timothy SEIDLER ◽  
Richard W. TROUGHTON ◽  
Timothy G. YANDLE ◽  
Christopher M. FRAMPTON ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Troponin T ◽  
Plasma Concentrations ◽  
Creatine Kinase Mb ◽  
Multiple Blood ◽  
Multiple Samples

Acute myocardial infarction (MI) results in activation of neurohormonal systems and increased plasma concentrations of myocardial enzymes and structural proteins. We hypothesized that plasma levels of N-terminal pro-brain natriuretic peptide (NT-BNP) would respond more vigorously after MI than those of other natriuretic peptides. We also sought to compare this response with that of the established myocardial injury markers troponin T (TnT), myoglobin and creatine kinase MB (CK-MB). We obtained multiple blood samples for measurement of atrial natriuretic peptide (ANP), N-terminal pro-ANP, brain natriuretic peptide (BNP) and NT-BNP along with CK-MB, TnT and myoglobin in 24 patients presenting to the Coronary Care Unit within 6 h of onset of MI. Multiple samples were obtained in the first 24 h, then at 72 h, 1 week, 6 weeks and 12 weeks. NT-BNP increased rapidly to peak at 24 h and exhibited greater (P<0.001) absolute increments from baseline compared with BNP and ANP, whereas NT-ANP did not change from baseline. Proportional increments in NT-BNP were also greater than those for the other natriuretic peptides (P<0.05). Natriuretic peptide levels reached their peak around 24 h, later than peak TnT, CK-MB and myoglobin (peak between 1–10 h), and NT-BNP and ANP remained elevated on average for 12 weeks. Our present results, with detailed sampling of a cohort of acute MI patients, demonstrate greater absolute and proportional increments in NT-BNP than ANP or BNP with sustained elevation of these peptides at 12 weeks.

scholarly journals Kreatinkinazės MB frakcijos reikšmė perioperacinio miokardo infarkto diagnostikoje

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Gediminas Kitra ◽  
Gediminas Kundrotas ◽  
Vilija Jakumaitė
Keyword(s):  
Myocardial Infarction ◽  
Creatine Kinase ◽  
Myocardial Injury ◽  
Postoperative Morbidity ◽  
Heart Surgery ◽  
Diagnostic Value ◽  
Perioperative Myocardial Infarction ◽  
Hospital Department ◽  
Routine Measurement ◽  
Creatine Kinase Mb

Gediminas Kitra1, Gediminas Kundrotas1, Vilija Jakumaitė1,21 Klaipėdos jūrininkų ligoninės Kardiochirurgijos skyrius,Liepojos g. 45, LT-92288 Klaipėda2 Kauno medicinos universiteto Psichofiziologijos ir reabilitacijos institutas,Vydūno al. 4, LT-00135 PalangaEl paštas: [email protected] Įvadas / tikslas Perioperacinis miokardo infarktas (PMI) po širdies operacijos didina pooperacinį sergamumą ir mirštamumą. Iki šiol nėra vienodų kriterijų PMI po aortos vainikinių jungčių operacijos diagnozuoti. Šio darbo tikslas – įvertinti kreatinkinazės MB frakcijos diagnostinę reikšmę. Ligoniai ir metodai Tirti 706 ligoniai, kuriems nuo 2004 m. sausio 2 d. iki 2007 m. vasario 22 d. buvo darytos aortos vainikinių jungčių operacijos naudojant dirbtinę kraujo apytaką (DKA). 69 (10%) ligoniams, remiantis elektrokardiograma ir kreatinkinazės MB koncentracijos padidėjimu, diagnozuotas PMI, 101 (14%) ligoniui nustatytas kreatinkinazės padidėjimas nesiekė diagnostinės ribos, jų miokardo pažeidimas vertintas kaip galimas perioperacinis miokardo pažeidimas. Rezultatai Ligoniams, kuriems yra PMI ir galimas PMI, pooperacinė eiga dažniau komplikavosi ūminiu širdies nepakankamumu. Šiose grupėse buvo didesnis hospitalinis mirštamumas, tačiau ligonių, kuriems buvo galimas PMI, mirštamumas dėl kardialinių priežasčių buvo mažesnis ir nesiskyrė nuo ligonių, kuriems miokardas nebuvo pažeistas. Išvados Rutininis kreatinkinazės MB frakcijos tyrimas po aortos vainikinių jungčių operacijos padeda diagnozuoti PMI ir prognozuoti tolesnę pooperacinę eigą. Kreatinkinazės MB frakcijos (CKMB) padidėjimas >100 u/l lemia didesnį hospitalinį mirštamumą. CKMB padidėjimas <100 u/l hospitaliniam mirštamumui įtakos neturi, tačiau lemia dažnesnį širdies nepakankamumą. Pagrindiniai žodžiai: perioperacinis miokardo infarktas, kreatinkinazės MB frakcija Significance of creatine kinase MB for the detection of perioperative myocardial infarction Gediminas Kitra1, Gediminas Kundrotas1, Vilija Jakumaitė1,21 Klaipėda Seamen’s Hospital, Department of Cardiosurgery,Liepojos str. 45, LT-92288 Klaipėda, Lithuania2 Institute of Psychophysiology and Rehabilitation, Kaunas University of Medicine,Vydūno ave. 4, LT-00135 Palanga, LithuaniaE-mail: [email protected] Background / objective Perioperative myocardial infarction (PMI) after heart surgery increases postoperative morbidity and mortality. Until now there are no universal criteria to confirm the diagnosis of PMI. We analysed the diagnostic value of creatine kinase MB fraction. Patients and methods 706 patients who underwent CABG with CPB from January 2, 2004 until February 22, 2007 were analyzed. 69 (10%) sustained PMI. The diagnosis was based on electrocardiogram and CKMB elevation. 101 (14%) were considered to have probable PMI, because their CKMB didn’t reach the diagnostic value. Results The postoperative course was complicated by acute heart failure more frequently in those with PMI and probable PMI. Hospital mortality was also higher in these patients. However, mortality from cardiac courses was lower in the group with probable PMI and similar to that in patients without perioperative myocardial injury. Conclusions Routine measurement of CKMB after CABG is of great importance in diagnosing PMI and predicts the clinical outcome. Key words: perioperative myocardial infarction, creatine kinase MB fraction

Clinical evaluation of an immunoinhibition procedure for creatine kinase-MB.

1980 ◽  
Vol 26 (1) ◽  
pp. 150-152 ◽  
Author(s):  
D Obzansky ◽  
J A Lott
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Sensitivity And Specificity ◽  
Clinical Evaluation ◽  
Creatine Kinase Isoenzyme ◽  
Creatine Kinase Mb ◽  
Diagnostic Sensitivity And Specificity ◽  
Creatine Kinase Isoenzyme Mb

Abstract We have clinically evaluated the Dade "Cardiozyme" immunoinhibition procedure for determination of creatine kinase isoenzyme MB (CK-MG) in 71 patients who were suspected of having had an acute myocardial infarction. Electrophoresis for CK-MB was also carried out. On the basis of diagnostic sensitivity and specificity for myocardial infarction, we found the Dade procedure for CK-MB to be somewhat inferior to electrophoresis. In 11 patients for whom the time of infarction was known, we observed normal CK-MB results for two of them by both immunoinhibition and electrophoresis during the first 24 h, but subsequently could detect abnormal CK-MB results by both methods. Thus in some patients such data are not helpful for making a diagnosis in the first 24 h. The Dade procedure is easy to perform, but lacks sensitivity in the region of low CK-MB activity, requires a very stable spectrophotometer, is imprecise, and produces negative numerical results in patients without myocardial infarction.

scholarly journals Relation between three-dimensional and two-dimensional echocardiography and biochemical analysis in patients with ST-segment elevation myocardial infarction percutaneously treated

2010 ◽  
Vol 8 (1) ◽  
pp. 53-61
Author(s):  
Marcelo Luiz Campos Vieira ◽  
Wercules Antônio Oliveira ◽  
Alexandre Ferreira Cury ◽  
Adriana Cordovil ◽  
Ana Clara Tude Rodrigues ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Creatine Kinase ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Creatine Kinase Mb

ABSTRACT Objective: The prognosis of patients with acute myocardial infarction depends on multiple features that can demonstrate myocardial injury degree (such as serum markers of cardiac necrosis), and also on adaptive mechanisms relative to the acute event. The aim of the study was to assess the relation between biochemical and echocardiographic findings from three-dimensional echocardiographic (3D Echo) analysis and echocardiographic two-dimensional (2D Echo) left ventricular ejection fraction in patients with ST-segment elevation acute myocardial infarction, submitted to primary percutaneous treatment. Methods: A prospective study with 2D Echo and 3D Echo of 23 patients (17 males, mean age of 57 ± 13 years) with ST-segment elevation acute myocardial infarction, primarily percutaneously treated (stent). Serum cardiac markers (creatine kinase MB, Troponin I and Myoglobin) and serum brain natriuretic peptide were compared to echocardiographic parameters (volumes, left ventricular ejection fraction and ventricular dyssynchrony index). The statistical analysis was performed using Pearson's correlation coefficient, 95% CI, p < 0.05, linear regression equation and Bland & Altman test. Results: Pearson's correlation coefficient (r)relative to 3D left ventricular ejection fraction: 1- brain natriuretic peptide: r: - 0.7427, p < 0.0001; 2- creatine kinase MB: r: - 0.660, p = 0.001. Left ventricular ejection fraction 2D (r) : 1- brain natriuretic peptide: r: - 0.5478, p = 0.001; 2- creatine kinase MB: r: - 0.4800, p < 0.0277. Other associations were not significant. Conclusions: In this series, it was observed better correlation in regard to serum creatine kinase MB, brain natriuretic peptide and 3D Echo left ventricular ejection fraction, when compared to 2D Echo left ventricular ejection fraction.

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