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. 1983 Apr;49(4):373–380. doi: 10.1136/hrt.49.4.373

Infarct size estimation from serial CK MB determinations: peak activity and predictability.

J W Fiolet, H F ter Welle, F J van Capelle, K I Lie
PMCID: PMC481316  PMID: 6830671

Abstract

In 198 patients with acute myocardial infarction serial measurements of plasma creatine kinase isoenzyme MB (CK MB) were performed at four hour intervals. In every patient, maximal CK MB activity (peak activity) was compared with calculated total release per litre plasma. In 28 patients (group 1) sufficient plasma samples were available for calculation of the apparent first order inactivation constant kd. Mean apparent kd in group 1 patients was 0 . 085 +/- 0 . 018 h-1 (mean +/- SD). Total release in group 1 was calculated with individual apparent kd values (Q) and with the mean kd value (Q*). In the remaining 170 patients (group 2), Q* only was calculated. A linear relation between peak activity P and total release (both Q and Q*) was found, extending over the whole range of CK MB peak activities that are routinely observed (4-216 U/l). It was immaterial whether a one or a two compartment model was used: both yielded a close linear relation. Though the mean ratio between Q* and peak activity depends on the value of kd chosen for calculation of total release (the ratio increasing with increasing kd), linearity between peak activity and Q* was found for any value of kd up to 0 . 4 h-1. In group 1, shapes of calculated CK MB release curves Q*(t), expressed relative to maximal release Q(40), were sufficiently similar so as to be superimposable; the section of the release curves extending from 12 hours before until two hours after peak time could be tentatively described by a linear time course with a slope of 4 . 2 +/- 0 . 5% per hour (mean +/- SD). We conclude that peak activity of CK MB is a reliable estimate of cumulative CK MB release and may be clinically more practicable than calculation of Q(40). Both the similarity and the large apparently linear section of the calculated enzyme release curves possibly permit early prediction of Q(40), with acceptable precision.

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Selected References

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  1. Bleifeld W., Mathey D., Hanrath P., Buss H., Effert S. Infarct size estimated from serial serum creatine phosphokinase in relation to left ventricular hemodynamics. Circulation. 1977 Feb;55(2):303–311. doi: 10.1161/01.cir.55.2.303. [DOI] [PubMed] [Google Scholar]
  2. Chapelle J. P., Albert A., Heusghem C., Smeets J. P., Kulbertus H. E. Predictive value of serum enzyme determinations in acute myocardial infarction. Clin Chim Acta. 1980 Sep 8;106(1):29–38. doi: 10.1016/0009-8981(80)90371-x. [DOI] [PubMed] [Google Scholar]
  3. Danner S. A., Smit E. M., Hart G. A., Oosting H., Dunning A. J. Prediction of infarct size from serial CK determinations: evaluation by clinical studies and computer simulation. Clin Chim Acta. 1979 Sep 15;97(1):45–57. doi: 10.1016/0009-8981(79)90024-x. [DOI] [PubMed] [Google Scholar]
  4. Fiolet J. W., Willebrands A. F., Lie K. I., ter Welle H. F. Determination of creatine kinase isoenzyme MB (CK-MB): comparison of methods and clinical evaluation. Clin Chim Acta. 1977 Oct 1;80(1):23–35. doi: 10.1016/0009-8981(77)90260-1. [DOI] [PubMed] [Google Scholar]
  5. Grande P., Hansen B. F., Christiansen C., Naestoft J. Acute myocardial infarct size estimated by serum CK-MB determinations: clinical accuracy and prognostic relevance utilizing a practical modification of the isoenzyme approach. Am Heart J. 1981 May;101(5):582–586. doi: 10.1016/0002-8703(81)90224-6. [DOI] [PubMed] [Google Scholar]
  6. Grande P., Hansen B. F., Christiansen C., Naestoft J. Estimation of acute myocardial infarct size in man by serum CK-MB measurements. Circulation. 1982 Apr;65(4):756–764. doi: 10.1161/01.cir.65.4.756. [DOI] [PubMed] [Google Scholar]
  7. Grande P., Naestoft J., Christiansen C. An easy and reliable estimation of acute myocardial infarct size from serum CK-MB measurements. Eur J Cardiol. 1980 Jan;11(1):71–77. [PubMed] [Google Scholar]
  8. Hutchins G. M., Bulkley B. H. Infarct expansion versus extension: two different complications of acute myocardial infarction. Am J Cardiol. 1978 Jun;41(7):1127–1132. doi: 10.1016/0002-9149(78)90869-x. [DOI] [PubMed] [Google Scholar]
  9. Kahn J. C., Gueret P., Baudet M., Rocha P., Bardet J., Bourdarias J. P. Clinical assessment of infarct size by serial determinations of serum creatine phosphokinase activity. Eur J Cardiol. 1979 Jan;9(1):21–37. [PubMed] [Google Scholar]
  10. Mathey D., Biefield W., Hanrath P., Effert S. Attempt to quantitate relation between cardiac function and infarct size in acute myocardial infarction. Br Heart J. 1974 Mar;36(3):271–279. doi: 10.1136/hrt.36.3.271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Mathey D., Bleifeld W., Buss H., Hanrath P. Creatine kinase release in acute myocardial infarction: correlation with clinical, electrocardiographic, and pathological findings. Br Heart J. 1975 Nov;37(11):1161–1168. doi: 10.1136/hrt.37.11.1161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Norris R. M., Whitlock R. M., Barratt-Boyes C., Small C. W. Clinical measurement of myocardial infarct size. Modification of a method for the estimation of total creatine phosphokinase release after myocardial infarction. Circulation. 1975 Apr;51(4):614–620. doi: 10.1161/01.cir.51.4.614. [DOI] [PubMed] [Google Scholar]
  13. Rapaport E. The fractional disappearance rate of the separate isoenzymes of creatine phosphokinase in the dog. Cardiovasc Res. 1975 Jul;9(4):473–477. doi: 10.1093/cvr/9.4.473. [DOI] [PubMed] [Google Scholar]
  14. Roberts R., Sobel B. E. Effect of selected drugs and myocardial infarction on the disappearance of creatine kinase from the circulation in conscious dogs. Cardiovasc Res. 1977 Mar;11(2):103–112. doi: 10.1093/cvr/11.2.103. [DOI] [PubMed] [Google Scholar]
  15. Roe C. R. Validity of estimating myocardial infarct size from serial measurements of enzyme activity in the serum. Clin Chem. 1977 Oct;23(10):1807–1812. [PubMed] [Google Scholar]
  16. Ryan W., Karliner J. S., Gilpin E. A., Covell J. W., DeLuca M., Ross J., Jr The creatine kinase curve area and peak creatine kinase after acute myocardial infarction: usefulness and limitations. Am Heart J. 1981 Feb;101(2):162–168. doi: 10.1016/0002-8703(81)90660-8. [DOI] [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., Lavelle J. F., Covell J. W., Sobel B. E. Early estimation of myocardial damage in conscious dogs and patients with evolving acute myocardial infarction. J Clin Invest. 1973 Oct;52(10):2579–2590. doi: 10.1172/JCI107450. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Shell W. E., Sobel B. E. Biochemical markers of ischemic injury. Circulation. 1976 Mar;53(3 Suppl):I98–106. [PubMed] [Google Scholar]
  20. 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]
  21. Sobel B. E., Roberts R., Larson K. B. Estimation of infarct size from serum MB creatine phosphokinase activity: Applications and limitations. Am J Cardiol. 1976 Mar 31;37(4):474–485. doi: 10.1016/0002-9149(76)90385-4. [DOI] [PubMed] [Google Scholar]
  22. Willems G. M., Muijtjens A. M., Lambi F. H., Hermens W. T. Estimation of circulatory parameters in patients with acute myocardial infarction. Significance for calculation of enzymatic infarct size. Cardiovasc Res. 1979 Oct;13(10):578–587. doi: 10.1093/cvr/13.10.578. [DOI] [PubMed] [Google Scholar]
  23. Willems G. M., Visser M. P., Krill M. T., Hermens W. T. Quantitative analysis of plasma enzyme levels based upon simultaneous determination of different enzymes. Cardiovasc Res. 1982 Mar;16(3):120–131. doi: 10.1093/cvr/16.3.120. [DOI] [PubMed] [Google Scholar]
  24. Witteveen S. A., Hemker H. C., Hollaar L., Hermens W. T. Quantitation of infarct size in man by means of plasma enzyme levels. Br Heart J. 1975 Aug;37(8):795–803. doi: 10.1136/hrt.37.8.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Yasmineh W. G., Pyle R. B., Nicoloff D. M. Rate of decay and distribution volume of MB isoenzyme of creatine kinase, intravenously injected into the baboon. Clin Chem. 1976 Jul;22(7):1095–1097. [PubMed] [Google Scholar]
  26. van der Laarse A., Davids H. A., Hollaar L., van der Valk E. J., Witteveen S. A., Hermens W. T. Recognition and quantification of myocardial injury by means of plasma enzyme and isoenzyme activities after cardiac surgery. Br Heart J. 1979 Jun;41(6):660–667. doi: 10.1136/hrt.41.6.660. [DOI] [PMC free article] [PubMed] [Google Scholar]

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