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Prediction of left ventricular function in acute anterior myocardial infarction by serum creatine kinase activity and
Insights
This study shows that early ECG mapping and peak enzyme activity can estimate residual left ventricular function after anterior myocardial infarction (AMI). These noninvasive methods help assess heart function post-heart attack.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Acute myocardial infarction (AMI) significantly impacts left ventricular function.
- Accurate assessment of residual cardiac function is crucial for patient management after AMI.
Purpose of the Study:
- To investigate noninvasive methods for estimating residual left ventricular function following a first anterior AMI.
- To correlate cardiac enzyme levels and electrocardiogram (ECG) findings with left ventricular function.
Main Methods:
- 17 patients with first anterior AMI underwent right cardiac catheterization, serial creatine phosphokinase (CPK) and CPK-MB activity measurements, and 35-lead ECG mapping within 6 hours of symptom onset.
- Left ventricular function was assessed using the stroke index (SI) to mean pulmonary capillary wedge pressure (PCWP) ratio.
- Correlations were analyzed between SI/PCWP ratio, CPK/CPK-MB levels, peak enzymatic activity, early ST-segment elevation, and late ECG parameters.
Main Results:
- The SI/PCWP ratio inversely correlated with total CPK and CPK-MB released, peak enzymatic activity, and early ST-segment elevation.
- A direct correlation was observed between the SI/PCWP ratio and the ratio of R to Q+S waves on late ECG (48th hour).
Conclusions:
- Residual left ventricular function after anterior AMI can be estimated noninvasively.
- Early ECG mapping and peak enzymatic activity are valuable predictors of residual cardiac function in individual patients post-AMI.
Abstract:
Right cardiac catheterization, serial determination of creatine phosphokinase (CPK) and of CPK-MB activities, and precordial 35-lead ECG mapping were performed in 17 consecutive patients with a first anterior acute myocardial infarction (AMI) within 6 hours of the onset of symptoms. Left ventricular function as determined by the stroke index (SI, ml/m2) to mean pulmonary capillary wedge pressure (PCWP, mmHg) ratio inversely correlated either with the total CPK and CPK-MB released and with peak enzymatic activity, or with the entity of early (6th hour ECG) ST-segment elevation. Conversely, a direct correlation was found between the SI/PCWP ratio and the ratio of R to Q+S waves from late (48th hour) ECG. Residual left ventricular function after a first anterior AMI can therefore be estimated noninvasively in the individual patient by early precordial ECG mapping and by peak enzymatic activity.