Related Experiment Videos
Critical difference between serial measurements of CK-MB mass to detect myocardial damage
R J de Winter1, R W Koster, J P van Straalen
1Academic Medical Center, Department of Cardiology, University of Amsterdam, The Netherlands.
Insights
The critical difference in serial creatine kinase-MB (CK-MB) mass measurements can detect myocardial damage in patients without acute myocardial infarction (AMI). An increase of >2.0 microg/L signifies significant change, aiding in diagnosing cardiac injury.
Area of Science:
- Cardiology
- Biochemistry
- Clinical Diagnostics
Background:
- Serial measurements of creatine kinase-MB (CK-MB) mass are used to assess myocardial damage.
- Establishing a critical difference is crucial for interpreting serial CK-MB mass results accurately.
- Acute myocardial infarction (AMI) diagnosis relies on sensitive and specific biomarkers.
Purpose of the Study:
- To evaluate the critical difference in serial CK-MB mass measurements.
- To determine the utility of this critical difference in detecting myocardial damage in patients without AMI.
- To compare CK-MB mass changes with troponin T concentrations.
Main Methods:
- Studied 110 patients with acute myocardial infarction (AMI) ruled out.
- Collected blood samples at multiple time points (3-24 hours post-symptom onset).
- Defined a significant increase in CK-MB mass as >2.0 microg/L, based on a 72.6% critical difference.
Main Results:
- Twenty-three non-AMI patients showed a CK-MB mass increase >2.0 microg/L; five had normal troponin T.
- Twenty-two non-AMI patients had abnormal troponin T; 82% of these also had elevated CK-MB mass (>2.0 microg/L).
- The significant CK-MB mass increase was often detected between 5 and 12 hours post-symptom onset.
Conclusions:
- The critical difference for CK-MB mass, defined as >2.0 microg/L, effectively detects myocardial damage in patients without AMI.
- Serial CK-MB mass monitoring can identify cardiac injury even when troponin T levels are not significantly elevated.
- This diagnostic approach aids in the nuanced assessment of cardiac events in non-AMI patients.
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 microg/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 microg/L, but five of these did not have an abnormal concentration of troponin T (i.e., not >0.1 microg/L). Also among the 110 non-AMI patients, 22 did have an abnormal troponin T value, 18 of whom (82%) also had CK-MBmass increased by >2.0 microg/L. In 20 of the 23 patients with an increase in CK-MBmass >2.0 microg/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-MBmass defined as an increase >2.0 microg/L detected myocardial damage in patients without AMI.