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Estimation of acute myocardial infarct size in man by serum CK-MB measurements
Insights
Estimating myocardial infarct size using serum CK-MB levels can quantify irreversible injury in acute myocardial infarction. Adjusting CK-MB measurements for plasma volume significantly improves accuracy in determining infarct size.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Accurate assessment of myocardial infarct size is crucial for managing acute myocardial infarction.
- Serum creatine kinase-MB (CK-MB) is a biomarker used to estimate infarct size, but its accuracy can be affected by various factors.
Purpose of the Study:
- To determine the relationship between myocardial infarct size estimated by serum CK-MB methods and the extent of irreversible myocardial injury.
- To investigate factors influencing CK-MB levels, including depletion in infarcted tissue and recovery in plasma.
Main Methods:
- Infarct size was estimated using different mathematical models in 321 patients with acute myocardial infarction.
- Myocardial necrosis was determined by autopsy in 22 patients who died during hospitalization.
- CK-MB depletion in infarcted tissue and recovery in plasma were analyzed.
Main Results:
- Myocardial CK-MB depletion correlated positively with larger infarct sizes.
- Enzyme recovery in plasma was independent of infarct size.
- Correcting serum CK-MB for plasma volume changes significantly improved infarct size estimation (p < 0.05).
- A highly significant correlation (r = 0.85–0.89, p < 0.001) was found between measured and estimated infarct sizes.
Conclusions:
- Serum CK-MB methods, particularly when corrected for plasma volume, provide a reliable semiquantitative estimation of myocardial necrosis extent in vivo.
- This method aids in assessing irreversible injury in acute myocardial infarction.
Abstract:
This study was performed to determine the relationship between myocardial infarct size estimated by serum CK-MB methods and the extent of irreversible injury in acute myocardial infarction. In 321 consecutive patients, infarct size was estimated by different mathematical models, and in 22 patients who died in hospital, the extent of myocardial necrosis was determined by autopsy. We also investigated the depletion of CK-MB in infarcted tissue, the recovery of CK-MB in the plasma volume, and the estimation of CK-MB from plasma. Myocardial CK-MB depletion was relatively greater in the larger infarcts, whereas the recovery of enzyme in plasma was independent of the infarct size. Correction of serum CK-MB for changes in plasma volume improved the estimate significantly (p less than 0.05). The correlation between the measured infarct size (g) and the estimated infarct size (units per liter and gram-equivalents) was highly significant (r = 0.85--0.89, SEE = 23--27%, p less than 0.001). Thus, a semiquantitative expression of the extent of myocardial necrosis can be determined in vivo.