Evaluation of clinical utility of serum enzymes and troponin—T in the early stages of acute myocardial infarction |
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| Authors: | Hitesh Shah N Haridas |
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| Institution: | (1) Smt. N.H.L. Municipal Medical College, Ellisrbridge, Ahmedabad;(2) Department of Biochemistry Pramukh Swami Medical College, Shri Krishna Hospital and Medical Research Centre, Karamsad, Anand, Gujarat, India |
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| Abstract: | Laboratory infarction diagnostics are based on the detection of elevated serum activities of total Creatine Kinase (CK), Creatine
Kinase isoensyme MB, (CKMB), Lactate dehydrogenase (LDH), isoenzyme forms of LDH and transaminases. Determination of these
cardiac marker enzymes permits a highly sensitive diagnosis of transmural myocardial infarction. In such patients the diagnosis
of acute myocardial infarction can be confirmed by the clinical, symptoms, and changes in the ECG in addition to the enzyme
assays. The 50 AMI patients selected in the present study were those admitted to the ICCU of Shri Krishna Hospital, Karamsad.
The blood samples were taken at the time of admission (ie. within four hours of the start of chest pain). The samples were
analyzed for CK, CKMB, SGOT, (Serum glutamate oxaloactate transaminase) αHBDH α-hydroxybutyrate dehydrogenase and troponin
T. The serum CKMB activity in AMI showed an increase only 5–6 hours after the commencement of chest pain. The elevation in
SGOT and αHBDH was still delayed. At the same time we could observe that the cardiac Troponin T (cTnT) was elevated at the
time of admission of the patient itself. This increase of cTnT in AMI patients was 20 times higher than the normal blood donors.
The controls included 25 normal blood donors and 25 patients with polytraumatic injuries with no chest contusion. The study
shows that cTnT estimation could serve in the early diagnosis of AMI. The increase of cardiac troponin T in AMI patients was
20 times higher than the normal blood donors in AMI patients at the time of admission. Cardiac troponin T in serum appears
to be a more sensitive indicator of myocardial cell injury than CKMB activity and its detection in the circulation may be
a useful prognostic indicator in patients with unstable angina as well. When the blood of normal blood donors or that of patients
with polytraumatic injury was analysed the troponin T values were well within the normal range in both the above categories
showing that cardiac troponin T is highly specific for heart tissue. Although CKMB and cardiac troponin T are released soon
after the myocardial injury, the release of cardiac troponin T is much earlier than CKMB thereby invalidating the important
role of cardiac troponin T in diagnosing AMI. Cardiac troponin T has been shown to be highly sensitive for cardiac injury
and not elevated in any other trauma, heavy exercise or skeletal muscle injury. Cardiac troponin T is ordinarily undetectable
in healthy individuals, and so its measurement can serve as a powerful tool in the diagnosis of AMI. |
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| Keywords: | Cardiac Troponin T alpha hydroxybutyrate dehydrogenase Lactate dehydrogenase myocardial infarction |
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