Size estimation of acute myocardial infarction from serial serum myoglobin observations with due consideration of individual differences in basic kinetics.
Thirty-three consecutive patients suffering from acute myocardial infarction were studied. Serial serum myoglobin and CK-MB measurements were made, and in seven patients individual kinetic constants for myoglobin were available from previous single injection studies. A two-compartment model for myoglobin kinetics was used for infarct size estimation. Given values for the basic kinetic constants (elimination rate constant, exchange rate constants, and distribution volume), the adjustment of a flexible, parameterized 'blood-appearance rate-function', phi AMI (mg X h-1), allowed estimation of start-time (t0), peak-time (tpeak) and end-time (tend) of myoglobin inflow into blood from the infarct area, in addition to the total cumulative release (A), which was used as a measure of infarct size. Use of patient-mean values for the kinetic constants caused a mean difference in estimated 'infarct size' of 34% (n = 7). Individual estimation of the elimination rate constant from the 'final slope' of the serum myoglobin curve could neither be recommended from a theoretical point of view nor from the practical outcome of numerical calculations; the 'true' elimination rate constant is underestimated by a factor of about 10 on average. Good correlation was found between our myoglobin estimates of 'infarct size' (using patient-mean kinetic constants), and independent estimates from serial serum CK-MB data, as calculated by the use of the method by Sobel et al.. Large inter-individual variations were found in the estimated infarct parameters, a circumstance which is of special interest in evaluation of therapeutic intervention studies on AMI-patients, and in infarct size prediction calculations.[1]References
- Size estimation of acute myocardial infarction from serial serum myoglobin observations with due consideration of individual differences in basic kinetics. Groth, T., Hakman, M., Sylvén, C. Scand. J. Clin. Lab. Invest. (1984) [Pubmed]
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