Abstract
In an attempt to develop improved methods of prediction of infarct size by enzymatic methods, Shell's original algorithm has been critically evaluated in an unselected series of patients. Poor performance of the model is partly the result of a systematic source of error associated with its mathematical formulation. A new model devoid of such limitations has therefore been developed. Residual deviations between predicted and observed CK release seem to be related to frequent and unpredictable extensions of infarction which could be verified by independent clinical, electrocardiographic, and enzymatic criteria. The modified model may possibly be applied to the evaluation of agents aimed at limiting the spread of irreversible injury.
Full text
PDF






Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- 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]
- 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]
- Gutovitz A. L., Sobel B. E., Roberts R. Progressive nature of myocardial injury in selected patients with cardiogenic shock. Am J Cardiol. 1978 Mar;41(3):469–475. doi: 10.1016/0002-9149(78)90001-2. [DOI] [PubMed] [Google Scholar]
- Gutovitz A. L., Sobel B. E., Roberts R. Progressive nature of myocardial injury in selected patients with cardiogenic shock. Am J Cardiol. 1978 Mar;41(3):469–475. doi: 10.1016/0002-9149(78)90001-2. [DOI] [PubMed] [Google Scholar]
- Inoue M., Hori M., Fukui S., Abe H., Minamino T. Evaluation of evolution of myocardial infarction by serial determinations of serum creatine kinase activity. Br Heart J. 1977 May;39(5):485–492. doi: 10.1136/hrt.39.5.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- 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]
- 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]
- 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]
- Reid P. R., Taylor D. R., Kelly D. T., Weisfeldt M. L., Humphries J. O., Ross R. S., Pitt B. Myocardial-infarct extension detected by precordial ST-segment mapping. N Engl J Med. 1974 Jan 17;290(3):123–128. doi: 10.1056/NEJM197401172900302. [DOI] [PubMed] [Google Scholar]
- Roe C. R., Starmer C. F. A sensitivity analysis of enzymatic estimation of infarct size. Circulation. 1975 Jul;52(1):1–5. doi: 10.1161/01.cir.52.1.1. [DOI] [PubMed] [Google Scholar]
- Rosalki S. B. An improved procedure for serum creatine phosphokinase determination. J Lab Clin Med. 1967 Apr;69(4):696–705. [PubMed] [Google Scholar]
- 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]
- 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]
- Shell W. E., Sobel B. E. Protection of jeopardized ischemic myocardium by reduction of ventricular afterload. N Engl J Med. 1974 Sep 5;291(10):481–486. doi: 10.1056/NEJM197409052911001. [DOI] [PubMed] [Google Scholar]
- Sobel B. E., Markham J., Karlsberg R. P., Roberts R. The nature of disappearance of creatine kinase from the circulation and its influence on enzymatic estimation of infarct size. Circ Res. 1977 Dec;41(6):836–844. doi: 10.1161/01.res.41.6.836. [DOI] [PubMed] [Google Scholar]
- Sobel B. E., Markham J., Roberts R. Factors influencing enzymatic estimates of infarct size. Am J Cardiol. 1977 Jan;39(1):130–132. doi: 10.1016/s0002-9149(77)80024-6. [DOI] [PubMed] [Google Scholar]
- Tommasini G., Cobelli F., Birolli M., Oddone A., Orlandi M., Malusardi R. Mappaggio precordiale ed analisi enzimatica nella valutazione quantitativa della necrosi miocardica. G Ital Cardiol. 1976;6(7):1201–1209. [PubMed] [Google Scholar]
- Varonkov Y., Shell W. E., Smirnov V., Gukovsky D., Chazov E. I. Augmentation of serum CPK activity by digitalis in patients with acute myocardial infarction. Circulation. 1977 May;55(5):719–727. doi: 10.1161/01.cir.55.5.719. [DOI] [PubMed] [Google Scholar]
