A comprehensive estimation of acute myocardial infarct size using enzymatic, electrocardiographic and mechanical methods

• Published in: The American journal of cardiology Vol. 59; no. 15; pp. 1239 - 1244
• Main Authors: Grande, Peer, Hindman, Nancy B., Saunamäki, Kari, Prather, John D., Hinohara, Tomoaki, Wagner, Galen S.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.1987; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Creatine Kinase - blood; Echocardiography; Electrocardiography; Female; Heart; Humans; Isoenzymes; Male; Medical sciences; Middle Aged; Myocardial Infarction - enzymology; Myocardial Infarction - physiopathology; Prospective Studies; Human; Echocardiography; Prognosis; Infarct; Creatine kinase; Isozyme; Acute; Abnormal QRS complex; Ultrasonic investigation; Cardiovascular disease; Coronary heart disease; Electrodiagnosis; Enzymatic activity; Left ventricular asynergy; Myocardium; Two dimensional technique
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(87)90897-6

This prospective study compares the estimated size of acute myocardial infarction (AMI) by cumulative serum creatine kinase isoenzyme MB (CK-MB), Selvester QRS score, and 2-dimensional (2-D) echocardiographic dyssynergy of the left ventricle in 63 consecutive patients with their first anterior (n = 31) or inferior AMI (n = 32). The correlations among these parameters were good for patients with anterior AMI (r = 0.74 to 0.78, standard error of the estimate = 29 to 33%) but only fair for those with inferior AMI (r = 0.35 to 0.47, standard error of the estimate = 38 to 73%). Based on previous autopsy studies, estimates of CK-MB and QRS score were then converted to percent of infarcted left ventricle. Linear regression analyses between mean percent AMI size by cumulative CK-MB plus QRS score vs the number of dyssynergic segments by 2-D echocardiography were used to develop a comprehensive formula for estimating AMI size by a combination of all 3 techniques. Thus, a formula is proposed that may optimally estimate AMI size derived from leakage of cytosolic enzymes, changes in the sequence of myocardial depolarization, and irregularities of left ventricular contraction.