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The Journal of Clinical Investigation logoLink to The Journal of Clinical Investigation
. 1973 Oct;52(10):2579–2590. doi: 10.1172/JCI107450

Early Estimation of Myocardial Damage in Conscious Dogs and Patients with Evolving Acute Myocardial Infarction

William E Shell 1,2, John F Lavelle 1,2, James W Covell 1,2, Burton E Sobel 1,2
PMCID: PMC302518  PMID: 4729051

Abstract

To estimate the ultimate extent of myocardial damage during evolving myocardial infarction in conscious dogs and patients, we analyzed early serum creatine phosphokinase (CPK) changes with nonlinear curve-fitting techniques. In experiments with dogs, serial serum CPK changes were fit to a log-normal function by the least squares method; the extent of the completed infarct was calculated by analysis of observed serum CPK changes and verified by measurement of myocardial CPK depletion 24 h after coronary occlusion. Early prediction of myocardial damage was based on projected serum CPK values from best fit curves based on data obtained during the first 5 h after initial elevation of enzyme activity. The correlation between predicted and observed values was close (r > 0.96, n = 11). In 11 additional conscious animals subjected to coronary occlusion, isoproterenol was administered continuously as soon as damage had been estimated from projected serum CPK values. The extent of the completed infarct was assessed by analysis of all serial serum CPK values and verified by analysis of myocardial CPK depletion 24 h after coronary occlusion. In each experiment the calculated completed infarct size exceeded infarct size projected before administration of isoproterenol (average increase = 44±10 [SE]%). When similar calculations were applied in experiments with eight dogs treated with propranolol, myocardial salvage was detected in 50% of the animals.

In 30 patients with uncomplicated acute myocardial infarction the extent of the completed infarct, measured by analysis of CPK activity in serum samples obtained every 2 h, was compared with damage estimated from CPK values projected by the best fit log-normal curve derived from data obtained during the first 7 h after the initial serum CPK elevation. The estimate of damage based on early data correlated closely with the extent of infarction calculated from all available serial serum CPK values (r = 0.93, n = 30). Thus, the extent of the completed infarct could be estimated accurately during the early evolution of infarction. In patients with spontaneous extension of infarction manifested by chest pain and electrocardiographic changes, the calculated extent of the completed infarct exceeded that predicted. Conversely, salvage of myocardium, after reduction of myocardial oxygen requirements by administration of trimethaphan, was reflected by reduction of the extent of the calculated completed infarct with respect to that predicted from early serum CPK changes.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AGRESS C. M., JACOBS H. I., GLASSNER H. F., LEDERER M. A., CLARK W. G., WROBLEWSKI F., KARMEN A., LADUE J. S. Serum transaminase levels in experimental myocardial infarction. Circulation. 1955 May;11(5):711–713. doi: 10.1161/01.cir.11.5.711. [DOI] [PubMed] [Google Scholar]
  2. Cox J. L., McLaughlin V. W., Flowers N. C., Horan L. G. The ischemic zone surrounding acute myocardial infarction. Its morphology as detected by dehydrogenase staining. Am Heart J. 1968 Nov;76(5):650–659. doi: 10.1016/0002-8703(68)90164-6. [DOI] [PubMed] [Google Scholar]
  3. Ginks W. R., Sybers H. D., Maroko P. R., Covell J. W., Sobel B. E., Ross J., Jr Coronary artery reperfusion. II. Reduction of myocardial infarct size at 1 week after the coronary occlusion. J Clin Invest. 1972 Oct;51(10):2717–2723. doi: 10.1172/JCI107091. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Harnarayan C., Bennett M. A., Pentecost B. L., Brewer D. B. Quantitative study of infarcted myocardium in cardiogenic shock. Br Heart J. 1970 Nov;32(6):728–732. doi: 10.1136/hrt.32.6.728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Killen D. A., Tinsley E. A. Serum enzymes in experimental myocardial infarcts. Relation of blood levels of serum glutamic oxaloacetic transaminase, lactic dehydrogenase, and heat stable lactic dehydrogenase to size of experimental myocardial infarct. Arch Surg. 1966 Mar;92(3):418–422. doi: 10.1001/archsurg.1966.01320210098021. [DOI] [PubMed] [Google Scholar]
  6. Killip T., 3rd, Kimball J. T. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967 Oct;20(4):457–464. doi: 10.1016/0002-9149(67)90023-9. [DOI] [PubMed] [Google Scholar]
  7. Kjekshus J. K., Sobel B. E. Depressed myocardial creatine phosphokinase activity following experimental myocardial infarction in rabbit. Circ Res. 1970 Sep;27(3):403–414. doi: 10.1161/01.res.27.3.403. [DOI] [PubMed] [Google Scholar]
  8. LEMLEY-STONE J., MERRILL J. M., GRACE J. T., MENEELY G. R. Transaminase in experimental myocardial infarction. Am J Physiol. 1955 Dec;183(3):555–558. doi: 10.1152/ajplegacy.1955.183.3.555. [DOI] [PubMed] [Google Scholar]
  9. Maroko P. R., Kjekshus J. K., Sobel B. E., Watanabe T., Covell J. W., Ross J., Jr, Braunwald E. Factors influencing infarct size following experimental coronary artery occlusions. Circulation. 1971 Jan;43(1):67–82. doi: 10.1161/01.cir.43.1.67. [DOI] [PubMed] [Google Scholar]
  10. Maroko P. R., Libby P., Covell J. W., Sobel B. E., Ross J., Jr, Braunwald E. Precordial S-T segment elevation mapping: an atraumatic method for assessing alterations in the extent of myocardial ischemic injury. The effects of pharmacologic and hemodynamic interventions. Am J Cardiol. 1972 Feb;29(2):223–230. doi: 10.1016/0002-9149(72)90633-9. [DOI] [PubMed] [Google Scholar]
  11. Maroko P. R., Libby P., Sobel B. E., Bloor C. M., Sybers H. D., Shell W. E., Covell J. W., Braunwald E. Effect of glucose-insulin-potassium infusion on myocardial infarction following experimental coronary artery occlusion. Circulation. 1972 Jun;45(6):1160–1175. doi: 10.1161/01.cir.45.6.1160. [DOI] [PubMed] [Google Scholar]
  12. NACHLAS M. M., FRIEDMAN M. M., COHEN S. P. A METHOD FOR THE QUANTITATION OF MYOCARDIAL INFARCTS AND THE RELATION OF SERUM ENZYME LEVELS TO INFARCT SIZE. Surgery. 1964 May;55:700–708. [PubMed] [Google Scholar]
  13. NACHLAS M. M., SHNITKA T. K. Macroscopic identification of early myocardial infarcts by alterations in dehydrogenase activity. Am J Pathol. 1963 Apr;42:379–405. [PMC free article] [PubMed] [Google Scholar]
  14. NYDICK I., WROBLEWSKI F., LADUE J. S. Evidence for increased serum glutamic oxalacetic transaminase (SGO-T) activity following graded myocardial infarcts in dogs. Circulation. 1955 Aug;12(2):161–168. doi: 10.1161/01.cir.12.2.161. [DOI] [PubMed] [Google Scholar]
  15. Page D. L., Caulfield J. B., Kastor J. A., DeSanctis R. W., Sanders C. A. Myocardial changes associated with cardiogenic shock. N Engl J Med. 1971 Jul 15;285(3):133–137. doi: 10.1056/NEJM197107152850301. [DOI] [PubMed] [Google Scholar]
  16. Reid D. S., Pelides L. J., Shillingford J. P. Surface mapping of RS-T segment in acute myocardial infarction. Br Heart J. 1971 May;33(3):370–374. doi: 10.1136/hrt.33.3.370. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Shell W. E., Kjekshus J. K., Sobel B. E. Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial changes in serum creatine phosphokinase activity. J Clin Invest. 1971 Dec;50(12):2614–2625. doi: 10.1172/JCI106762. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Shell W. E., Sobel B. E. Deleterious effects of increased heart rate on infarct size in the conscious dog. Am J Cardiol. 1973 Apr;31(4):474–479. doi: 10.1016/0002-9149(73)90297-x. [DOI] [PubMed] [Google Scholar]
  19. Sobel B. E., Bresnahan G. F., Shell W. E., Yoder R. D. Estimation of infarct size in man and its relation to prognosis. Circulation. 1972 Oct;46(4):640–648. doi: 10.1161/01.cir.46.4.640. [DOI] [PubMed] [Google Scholar]

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