Establishing the role of serum cardiac markers in diagnosis of acute chest pain(A Study of 200 cases)

  • Dr. Sameep Garg Department of Pathology, Gujarat Adani Institute of Medical Science, Bhuj, Kutchh, Gujarat, India
  • Dr. Mitsu Vaishnav Department of Pathology, Gujarat Adani Institute of Medical Science, Bhuj, Kutchh, Gujarat, India
Keywords: hsTroponin I, MyocardialInfarction, CK-MB, LDH

Abstract

Introduction:Acute myocardial infarction (AMI) continues to be a major health problem in industrialized and developing countries like India despite progressive research in diagnostic and management over last three decades.AMI has typically been diagnosed on the basis of triad of clinical syndromes of chest pain, electrocardiogram (ECG) changes and elevated serum enzyme activity.Due to high cardiac specificity of ckmb,cTnI, these biomarkers have become the recommended biomarkers for the diagnosis of myocardial injury.

Aims:To study changes in serum cardiac markers and determine the sensitivity and specificity of Highly sensitive Troponin I, CK-MB and LDH.

Material and Methods:It was undertaken from November-2015 to December-2016 during which 200 patients were studied. All the patients having complaint of acute chest pain admitted in the emergency wards are included. Serum level of cardiac Troponin I was determined by using vidashigh sensitive troponin i (human cardiac specific) enzyme immunoassay kit, CK-MB was determined by the vitros 250 fully automated biochemistry analyser,serum level of LDH was determined by ldh-(p-l) reagent kit (kinatic procedure).

Result:In present study, out of 200 patients who admitted for complaining of acute chest pain, 110 patients actually diagnosed to have acute myocardial infarction. Sensitivity and specificity of hsTroponin I for diagnosis of acute myocardial infarction was 100%. CK-MB was 89.1% and 88.8% andLDH was 65.4% and 60% respectively.

Conclusion:Among the cardiac markers studied hsTroponin I is the most specific and sensitive for diagnosis of acute myocardial infarction. As CK-MB levels become normal within 2-3 days, it is helpful in diagnosis of reinfarction.

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References

1. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (Second of two parts). N Engl J Med 1992 Jan 30;326(5):310-8.)[pubmed]



2. Harrison’s principles of Internal medicine 16th edition; vol 2; chapter – 288; ST Segment elevation myocardial inflammation; page – 1448.



3. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000 Apr 20;342:1163-70.)[pubmed]



4. Nomenclature and criteria for diagnosis of ischemic heart disease. Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature. Circulation. 1979;59:607-9. )[pubmed]



5. Vaidya HC, Maynard Y, Dietzler DN, Ladenson JH. Direct measurement of creatine kinase-MB activity in serum after extraction with a monoclonal antibody specific to the MB isoenzyme. Clinical chemistry. 1986 Apr;32(4):657-63.[pubmed]



6. Dolci A, Panteghini M. The exciting story of cardiac biomarkers: from retrospective detection to gold diagnostic standard for acute myocardial infarction and more. Clinicachimica acta; international journal of clinical chemistry. 2006 July 23;369(2):179-87.[pubmed]



7. Katus HA, Remppis A, Looser S, Hallermeier K, Scheffold T, Kubler W. Enzyme linked immuno assay of cardiac troponin T for the detection of acute myocardial infarction in patients. Journal of molecular and cellular cardiology. 1989 Dec;21(12):1349-53.[pubmed]



8. Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Clinical chemistry. 2007Apr 3;115(13):e356-75..[pubmed]



9. Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA. Analytical validation of a high-sensitivity cardiac troponin T assay. Clinical chemistry. 2010 Feb;56(2):254-61.[pubmed]



10. Alan C Wilson, Yu-Hsuan Shao, Nora M Cosgrove, John S Pantazopolous, Abel E Moreyra, John B Kostis. Changing Age Distribution of First Ever Acute Myocardial Infarction Among Men and Women in New Jersey Hospitals. Circulation. 2007;116(2):832.



11. Jan Mannsverk, Tom Wilsgaard,IngerNjolstad, Laila ArnesdatterHopstock,Maja-Lisa Lochen, Ellisiv B Mathiesen et al. Age and gender differences in incidence and case fatality trends for myocardial infarction: a 30-year follow-up. The TromsoStudy.European Journal of Preventive Cardiology. 2012(19) issue 5:927-934.[pubmed]


12. ShazibPervaiz, Philip Anderson, Thomas P. Lohmann, Charlotte J. Lawson, Yue-Jin Feng, Dave Waskiewicz. Comparative Analysis of Cardiac Troponin I and Creatine Kinase-MB as Markers of Acute Myocardial Infarction.Clin.Cardiol. 1997Mar;20:269-271.[pubmed]



13. DurdiQujeq. Rapid Diagnosis of Acute Myocardial Infarction.Iran. Biomed. J. 1999;3(1):59-62



14. Mahalaxmi.S.Petimani, P.SureshBabu. Study of cardiac troponin-i as a diagnostic marker in comparision with creatine kinase-mb in myocardial infarction.International Journal of Pharmacy and Biological Sciences. Jan-Mar 2013;3(1):89-97.



15. Kiran R Bagale1, Avinash S. Ingle. Role of CK-MB and Troponin-I in Diagnosing Non-ST-Elevation Myocardial Infarction.International Journal of Science and Research. 2014;3(8). Paper ID: 02015352.



16. Adams JE 3rd, Schechtman KB, Landt Y, Ladenson JH, Jaffe AS. Comparable detection of acute myocardial infarction by creatine kinase MB isoenzyme and cardiac troponin I. Clin Chem. 1994 Jul;40(7):1291-5.[pubmed]



17. Janice Zimmerman, Robert Fromm, Denise Meyer, Ann Boudreaux, Chuan-Chuan C. Wun, Richard Smalling, Barrry Davis, Gabriel Habib, Robert Roberts. Diagnostic marker cooperative study for the diagnosis of myocardial infarction.Circulation. 1999;99: 1671-1677.



18. Bock JL, Brogan GX Jr, McCuskey CF, Thode HC Jr, Hollander JE, Gunther T. Evaluation of CK-MB isoform analysis for early diagnosis of myocardial infarction.JEmerg Med. 1999 Jan-Feb;17(1):75-9.[pubmed]



19. Dhruva G. A., Agravat A. H.. Serum cardiac markers in patients of acute myocardial infarction. Journal of Cell and Tissue Research 2010;10(3):2343-2347.[pubmed]



20. Fitzgerald RL, Frankel WL, Herold DA.Comparison of Troponin-T with other cardiac markers.Am J ClinPathol. 1996 Sep;106(3):396-401.[pubmed]
Establishing the role of serum cardiac markers in diagnosis of acute chest pain(A Study of 200 cases)
CITATION
DOI: 10.17511/jopm.2018.i03.10
Published: 2018-07-31
How to Cite
Dr. Sameep Garg, & Dr. Mitsu Vaishnav. (2018). Establishing the role of serum cardiac markers in diagnosis of acute chest pain(A Study of 200 cases). Tropical Journal of Pathology and Microbiology, 4(3), 295-301. https://doi.org/10.17511/jopm.2018.i03.10
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Original Article