Estimation of enzymatic infarct size: Direct comparison of the marker enzymes creatine kinase and α-hydroxybutyrate dehydrogenase☆,☆☆,★
Section snippets
Patients
During the study period, patients with acute myocardial infarction lasting <6 hours and treated with intravenous thrombolysis who had no interventional procedures and survived at least 5 days were included. In addition to the typical clinical findings, inclusion criteria were ST elevations of ≥0.1 mV in two extremity electrocardiographic leads or ≥0.2 mV in two contiguous precordial leads, persistent after administration of sublingual nitroglycerin. Of 107 patients, 17 were excluded because of
Results
The mean values of enzymatic infarct size in all 90 patients were 803 ± 608 IU/L for mean HBDH release and 18.9 ± 19.6 IU/ml × hour for CK AUC. Comparison of both enzymatic infarct size measurements displayed a close correlation (r = 0.88, Fig. 1). Compared with CK AUC, however, cumulative HBDH release correlated better (differences between the correlations p < 0.001) with parameters of left
Discussion
In the early 1970s, two methods to assess enzymatic infarct size were reported.9, 11 The method of Shell et al.9 is based on a total CK recovery of only 15% to 30%.10 The method developed by Witteveen et al.11 is based on a two-compartment model for circulating enzymes and complete recovery of enzymes released from the infarcted myocardial tissue.11, 14 The actual estimates of infarct sizes are consistent with both methods, but the formulations used are different.12, 13 The validity of using
References (30)
- et al.
Effects of early intracoronary streptokinase on infarct size estimated from cumulative enzyme release and on enzyme release rate: a randomized trial of 533 patients with acute myocardial infarction
Am Heart J
(1986) - et al.
Prehospital thrombolysis: beneficial effects of very early treatment on infarct size and left ventricular function
J Am Coll Cardiol
(1993) - et al.
Effect of reperfusion on electrocardiographic and enzymatic infarct size: results of a randomized multicenter study of intravenous anisoylated plasminogen streptokinase activator complex (APSAC) versus intracoronary streptokinase in acute myocardial infarction
Am Heart J
(1988) - et al.
Assessment of myocardial damage in patients with acute myocardial infarction by serial measurement of serum a-hydroxybutyrate dehydrogenase levels
Am Heart J
(1984) - et al.
The creatine kinase curve area and peak creatine kinase after acute myocardial infarction: usefulness and limitations
Am Heart J
(1981) - et al.
Patterns of creatine kinase release during acute myocardial infarction after nonsurgical reperfusion: comparison with conventional treatment and correlation with infarct size
J Am Coll Cardiol
(1984) - et al.
A new approach for the enzymatic estimation of infarct size: serum peak creatine kinase and time to peak creatine kinase activity
Am J Cardiol
(1986) - et al.
Effects of coronary artery reperfusion on relation between creatine kinase-MB and infarct size estimated by myocardial emission tomography with thallium 201 in man
J Am Coll Cardiol
(1983) - et al.
Relation between infarct size and left ventricular performance assessed in patients with first acute myocardial infarction randomized to intracoronary thrombolytic therapy or to conventional treatment
Am J Cardiol
(1988) A prospective trial of intravenous streptokinase in acute myocardial infarction (ISAM)
N Engl J Med
(1986)
Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction
Br Med J
Limitation of infarct size and preservation of left ventricular function after primary coronary angioplasty compared with intravenous streptokinse in acute myocardial infarction
Circulation
Nachweis der Wiedereröffnung eines Infarktgefäßes durch serielle CK-MB- und CK-Bestimmung
Herz/Kreisl
Different effects of tissue plasminogen activator and streptokinase on infarct size and on rate of enzyme release: influence of early infarct-related patency-the GUSTO enzyme substudy
Eur Heart J
Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial creatine phosphokinase activity
J Clin Invest
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2011, International Journal of CardiologyCitation Excerpt :Serum level of creatine kinase MB (CK-MB, U/l) was determined at least three times within the first 24 h, and then after 36 and 48 h. The area under the curve of CK-MB release in the first 48 h (AUC, U/l × h) was calculated [17]. Two-dimensional echocardiography was performed at rest to evaluate LV ejection fraction (LVEF, %) by the biplane Simpson's method.
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From the Department of Cardiopulmology, Klinikum Benjamin Franklin, Free University Berlin.
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Reprint requests: Rolf Schröder, MD, Klinikum Benjamin Franklin Free University Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany.
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