Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1983 Jul;50(1):65–69. doi: 10.1136/hrt.50.1.65

Serum creatine kinase and creatine kinase MB isoenzyme responses of post-infarction patients after a graded exercise test.

B Davies, D A Watt, A Daggett
PMCID: PMC481372  PMID: 6860512

Abstract

The response of total creatine kinase (CK) and the creatine kinase isoenzyme (CK MB) was studied in 22 male post-infarction patients (three to six months after myocardial infarction) after a functional graded exercise test, before entering a rehabilitation programme. Eleven subjects (group A) completed the test without developing significant electrocardiographic abnormalities. Eleven subjects (group B) showed changes that necessitated premature termination of the test. No significant differences were observed before the functional graded exercise test between the groups in serum concentration of CK, CK MB, and the percentage of CK MB to CK (MB/ CK%). The two groups were significantly different (p less than 0.01) 24 hours after the graded exercise test in CK MB and MB/CK%, but not in CK. In group B, CK and CK MB rose significantly after the graded exercise test (p less than 0.05) as did MB/CK% (p less than 0.01). In group A only CK showed a significant rise (p less than 0.05). It is probable that increases in CK MB after exercise arise from myocardial tissue efflux, reflecting reversible ischaemia. It is concluded from this study that CK MB appears to be a specific indicator of myocardial ischaemia and could, therefore, be of significant assistance in the clinical and functional assessment of the post-infarction patient.

Full text

PDF
65

Selected References

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

  1. BALKE B., WARE R. W. An experimental study of physical fitness of Air Force personnel. U S Armed Forces Med J. 1959 Jun;10(6):675–688. [PubMed] [Google Scholar]
  2. Bartel A. G., Behar V. S., Peter R. H., Orgain E. S., Kong Y. Graded exercise stress tests in angiographically documented coronary artery disease. Circulation. 1974 Feb;49(2):348–356. doi: 10.1161/01.cir.49.2.348. [DOI] [PubMed] [Google Scholar]
  3. Berg A., Haralambie G. Changes in serum creatine kinase and hexose phosphate isomerase activity with exercise duration. Eur J Appl Physiol Occup Physiol. 1978 Sep 15;39(3):191–201. doi: 10.1007/BF00421346. [DOI] [PubMed] [Google Scholar]
  4. Borer J. S., Brensike J. F., Redwood D. R., Itscoitz S. B., Passamani E. R., Stone N. J., Richardson J. M., Levy R. I., Epstein S. E. Limitations of the electrocardiographic response to exercise in predicting coronary-artery disease. N Engl J Med. 1975 Aug 21;293(8):367–371. doi: 10.1056/NEJM197508212930801. [DOI] [PubMed] [Google Scholar]
  5. D'Souza J. P., Sine H. E., Horvitz R. A., Kubasik N. P., Brody B. B., Barold S. S. The significance of the MB isoenzyme in patients with acute cardiovascular disease with a normal or borderline total CPK activity. Clin Biochem. 1978 Oct;11(5):204–209. doi: 10.1016/s0009-9120(78)80029-0. [DOI] [PubMed] [Google Scholar]
  6. Davies B., Daggett A., Watt D. A. Serum creatine kinase and isoenzyme responses of veteran class fell runners. Eur J Appl Physiol Occup Physiol. 1982;48(3):345–354. doi: 10.1007/BF00430224. [DOI] [PubMed] [Google Scholar]
  7. Durnin J. V., Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr. 1974 Jul;32(1):77–97. doi: 10.1079/bjn19740060. [DOI] [PubMed] [Google Scholar]
  8. 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]
  9. Fortuin N. J., Weiss J. L. Exercise stress testing. Circulation. 1977 Nov;56(5):699–712. doi: 10.1161/01.cir.56.5.699. [DOI] [PubMed] [Google Scholar]
  10. Froelicher V. F., Jr, Yanowitz F. G., Thompson A. J., Lancaster M. C. The correlation of coronary angiography and the electrocardiographic response to maximal treadmill testing in 76 asymptomatic men. Circulation. 1973 Sep;48(3):597–604. doi: 10.1161/01.cir.48.3.597. [DOI] [PubMed] [Google Scholar]
  11. Goldschlager N., Selzer A., Cohn K. Treadmill stress tests as indicators of presence and severity of coronary artery disease. Ann Intern Med. 1976 Sep;85(3):277–286. doi: 10.7326/0003-4819-85-3-277. [DOI] [PubMed] [Google Scholar]
  12. KARVONEN M. J., KENTALA E., MUSTALA O. The effects of training on heart rate; a longitudinal study. Ann Med Exp Biol Fenn. 1957;35(3):307–315. [PubMed] [Google Scholar]
  13. Kraft J., Aastrup H., Schrøder P. Diagnostic value for acute myocardial infarction of creatine kinase and lactate dehydrogenase isoenzymes compared with total enzymes. Creatine kinase isoenzyme specificity for myocardial damage. Acta Med Scand. 1978;203(3):167–174. doi: 10.1111/j.0954-6820.1978.tb14851.x. [DOI] [PubMed] [Google Scholar]
  14. Lindsey D., Navin T., Finley P. Meaning of elevated CK-MB. Am Heart J. 1979 Sep;98(3):405–406. doi: 10.1016/0002-8703(79)90058-9. [DOI] [PubMed] [Google Scholar]
  15. Lozner E. C., Morganroth J. New criteria to enhance the predictability of coronary artery disease by exercise testing in asymptomatic subjects. Circulation. 1977 Nov;56(5):799–802. doi: 10.1161/01.cir.56.5.799. [DOI] [PubMed] [Google Scholar]
  16. Marmor A., Alpan G., Keidar S., Grenadier E., Palant A. The MB isoenzyme of creatine kinase as an indicator of severity of myocardial ischaemia. Lancet. 1978 Oct 14;2(8094):812–814. doi: 10.1016/s0140-6736(78)92590-4. [DOI] [PubMed] [Google Scholar]
  17. Marmor A., Keidar S., Grenadir E., Palant A. MB isoenzyme of creatine phosphokinase. Indicator of ischemia in coronary arterial disease. Chest. 1979 Jan;75(1):88–90. doi: 10.1378/chest.75.1.88. [DOI] [PubMed] [Google Scholar]
  18. Mercer D. W. Separation of tissue and serum creatine kinase isoenzymes by ion-exchange column chromatography. Clin Chem. 1974;20(1):36–40. [PubMed] [Google Scholar]
  19. Mercer D. W., Varat M. A. Detection of cardiac-specific creatine kinase isoenzyme in sera with normal or slightly increased total creatine kinase activity. Clin Chem. 1975 Jul;21(8):1088–1092. [PubMed] [Google Scholar]
  20. Redwood D. R., Borer J. S., Epstein S. E. Whither the ST segment during exercise. Circulation. 1976 Nov;54(5):703–706. doi: 10.1161/01.cir.54.5.703. [DOI] [PubMed] [Google Scholar]
  21. Redwood D. R., Epstein S. E. Uses and limitations of stress testing in the evaluation of ischemic heart disease. Circulation. 1972 Dec;46(6):1115–1131. doi: 10.1161/01.cir.46.6.1115. [DOI] [PubMed] [Google Scholar]
  22. Roberts R., Gowda K. S., Ludbrook P. A., Sobel B. E. Specificity of elevated serum MB creatine phosphokinase activity in the diagnosis of acute myocardial infarction. Am J Cardiol. 1975 Oct 6;36(4):433–437. doi: 10.1016/0002-9149(75)90890-5. [DOI] [PubMed] [Google Scholar]
  23. Roberts R., Sobel B. E. Creatine kinase isoenzymes in the assessment of heart disease. Am Heart J. 1978 Apr;95(4):521–528. doi: 10.1016/0002-8703(78)90245-4. [DOI] [PubMed] [Google Scholar]
  24. SHEFFIELD L. T., REEVES T. J. GRADED EXERCISE IN THE DIAGNOSIS OF ANGINA PECTORIS. Mod Concepts Cardiovasc Dis. 1965 Jan;34:1–6. [PubMed] [Google Scholar]
  25. Sakai K., Gebhard M. M., Spieckermann P. G., Bretschneider H. J. Enzyme release resulting from total ischemia and reperfusion in the isolated, perfused guinea pig heart. J Mol Cell Cardiol. 1975 Nov;7(11):827–840. doi: 10.1016/0022-2828(75)90134-0. [DOI] [PubMed] [Google Scholar]
  26. Sheffield L. T., Roitman D. Stress testing methodology. Prog Cardiovasc Dis. 1976 Jul-Aug;19(1):33–49. doi: 10.1016/0033-0620(76)90007-4. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES