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Troponin T concentrations 72 hours after myocardial infarction as a serological estimate of infarct size
M Licka1, R Zimmermann, J Zehelein
1Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
Insights
A single troponin T measurement 72 hours after myocardial infarction is superior for estimating infarct size compared to traditional markers like CK, CK-MB, and LDH. This method is independent of reperfusion therapy, offering a more precise assessment of irreversible myocardial damage.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Imaging
Background:
- Acute myocardial infarction (MI) leads to the release of cardiac biomarkers.
- Troponin T is released longer than other markers like creatine kinase (CK), CK-MB, and lactate dehydrogenase (LDH).
- Late troponin T release is less influenced by early coronary reperfusion after MI.
Purpose of the Study:
- To evaluate the precision of a single troponin T measurement 72 hours post-MI.
- To compare troponin T measurements with standard scintigraphic and enzymatic methods for estimating myocardial infarct size.
Main Methods:
- Quantitative single photon emission computed tomography (SPECT) thallium-201 scintigraphy was used.
- 37 patients were studied 2-3 weeks after MI, divided into groups with and without early coronary reperfusion.
- Reperfusion was achieved via thrombolytic therapy, percutaneous transluminal coronary angioplasty, or both.
Main Results:
- A significant correlation was found between troponin T concentrations at 72 hours and the extent of irreversible myocardial damage.
- This correlation held true regardless of early coronary reperfusion status.
- Troponin T measurements correlated significantly with peak CK, CK-MB, and LDH concentrations.
Conclusions:
- A single troponin T measurement 72 hours after MI is a superior method for estimating myocardial infarct size.
- This method is independent of reperfusion status, unlike peak CK, CK-MB, or LDH measurements.
- Troponin T offers a more precise assessment of irreversible myocardial damage compared to serial enzymatic determinations.
Background:
After acute myocardial infarction, the structural protein T is released considerably longer than cytosolic creatine kinase (CK), CK MB isoenzyme (CK-MB), or lactate dehydrogenase (LDH) and late troponin T release (> 48 hours after onset of chest pain) appears to be less affected by early coronary reperfusion.
Objective:
To investigate the precision of a single measurement of circulating troponin T concentrations 72 hours after onset of chest pain compared with standard scintigraphic and enzymatic estimates of myocardial infarct size.
Methods:
Quantitative single photon emission computed tomography thallium-201 scintigraphy at rest was performed in 37 patients 2-3 weeks after myocardial infarction (group 1: 14 patients without early coronary reperfusion; group 2: 23 patients with early reperfusion achieved by thrombolytic therapy, by percutaneous transluminal coronary angioplasty, or by both).
Results:
In both groups, the number of myocardial segments with abnormal thallium-201 uptake indicating the individual extent of irreversible myocardial damage correlated significantly with the troponin T concentrations 72 hours after infarction as well as with peak concentrations of CK, CK-MB, and LDH.
Conclusion:
The data show that a single measurement of circulating troponin T 72 hours after onset of chest pain--independent of reperfusion--is superior for the estimation of myocardial infarct size to measurement of peak CK, CK-MB, or LDH, which require serial determinations and depend on coronary reperfusion.
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