Abstract
Detection of cardiac damage is greatly facilitated by serial blood measurements of myocardial cell markers. In many hospitals creatine kinase MBmass concentration (CK MBmass) constitutes the biochemical criterion (WHO) for acute myocardial infarction (AMI). Cardiac troponin T (TnT) is an even more sensitive and specific marker for myocardial damage. With discriminator levels of 10.0 and 0.10μg/l, respectively, serial measurements of both markers provide a useful diagnostic strategy for ischemic heart disease. This survey reviews representative cumulated time curves in individual patients covering the spectrum of myocardial damage, including unstable angina pectoris (UAP), non and Q-wave infarctions with and without early reperfusion, re-infarction, and subacute infarction. Increased TnT detects minor myocardial damage (MMD) in over 30% of patients with UAP, although CK MBmass remains below its discriminator. Subacute infarction is detected by the wide diagnostic time window of the serum TnT at a time when CK MBmass has already returned to normal. In a substudy of 502 suspected cases of AMI, the distributions of maximum serum TnT concentrations within each patient series demonstrated that TnT had a diagnostic sensitivity of 100% and a specificity of 99%. Median, 5th and 95th percentiles of maximum TnT values within the diagnostic subgroups showed that serum TnT was increased five-fold more than CK MBmass. Median values of Q-wave AMI were higher than in non–Q-wave AMI. A diagnostic strategy using TROPT, a rapid test specific for the cardiac isoform of TnT with a detection limit 0.10μg/l, is presented.
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Gerhardt W, Waldenström JHørder M, et al. Creatine kinase and creatine kinase B-subunit activity in serum in cases of suspected myocardial infarction. Clin Chem 1982;28:277–283.
Gerhardt W, Waldenström J. Creatine kinase B-subunit activity in serum after imunoinhibition of M-subunit activity. Clin Chem 1979;25:1274–1280.
Gerhardt W, Hofvendahl S, Ljungdahl L, et al. Serum LD-1 activity in suspected acute myocardial infarction. Clin Chem 1983;29:1051–1060.
Gerhardt W, Ljungdahl L, Hofvendahl S. Serum Enzymes at Suspected Acute myocardial Infarction. Pictorial Atlas with Case Histories. Monograph. Darmstadt: GIT Verlag, 1988.
Gerhardt W, Katus H, Ravkilde J, et al. S-troponin T in suspected ischemic myocardial injury compared with mass and catalytic concentrations of S-creatine kinase isoenzyme MB. Clin Chem 1991;37:1405–1411.
Bhayana V, Henderson R. Biochemical markers of Myocardial Damage. Clin Biochemistry (Canada) 1995;28:1–29.
Gerhardt W, Ljungdahl L, Herbert AK. Troponin T and CK MBmass (mass) in early diagnosis of ischemic myocardial injury. The Helsingborg Study 1992. Clin Biochem (Canada) 1993;26:231–240.
Gerhardt W, Ljungdahl L. Rational diagnostic strategy in diagnosis of ischemic myocardial injury. S-troponin T and S-CK MBmass (mass) time series using individual baseline values. Scand J Clin Lab Invest 1993;53(Suppl 215):47–59.
Katus HA, Remppis Neumann FJ, et al. Diagnostic efficiency of troponin T measurements in acute myocardial infarction. Circulation 1991;83:902–912.
Katus, HA, Remppis A, Scheffold T, Diederich KW, Kuebler W. Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with perfused and nonreperfused myocardial infarction. Am J Cardiol 1991;67:1360–1367.
Katus HA, Looser, S, Hallermeyer K, et al. Development and in vitro characterization of a new immunoassay of cardiac troponin T. Clin Chem 1992;38:386–393.
Gerhardt W, Katus HA, Ravkilde J, Hamm C. S-troponin T as a marker of ischemic myocardial injury. Clin Chem 1992;1194–1195.
Mach F, Lovis C, Chevrolet J-C, et al. Rapid bedside whole blood cardiospecific troponin T immunoassay for the diagnosis of acute myocardial infarction. Am J Cardiol 1995;75:842–845.
Collinson PO, Thomas S, Siu L, Vasudeva P, Stubbs PJ, Canepa-Anson R. Rapid troponin T measurement in whole blood for detection of myocardial damage. Ann Clin Biochem 1995;32:454–458.
European Committee for Clinical Laboratory Standards (ECCLS). Gerhardt W (chairman), Bullock D, Duggan PF, Standards for Enzyme Determination. ECCLS Document ISSN 1011–6265 (may be requested from the author).
Gerhardt W, Keller H. Evaluation of test data from clinical studies. I. Terminology, graphic interpretation, diagnostic strategies, and selection of sample groups. Scand J Clin Lab Invest 1986;46(Suppl 181):1–74.
Remppis A, Scheffold T, Karrer O, et. al. Assessment of reperfusion of the infarct zone after myocardial infarction by serial troponin T measurements in seruum. Eur Heart J 1994;71:242–248.
Hamm C, Ravkilde J, Gerhardt W, et al. The prognostic value of troponin T in unstable angina. N Engl J Med 1992;327:146–150.
Collinson PO, Stubbs P. The prognostic value of serum troponin T in unstable angina. N Engl J Med 1992;327:1760–1761.
Ravkilde J, Horder M, Gerhardt W, et al. Diagnostic performance and prognostic value of serum troponin T in suspected acute myocardial infarction. Scand J Clin Lab Invest 1993;53:677–685.
Seino Y, Tomita Y, Takano T, Hayakawa H. Early detection of cardiac event with serum troponin T in patients with unstable angina. Lancet 1993;342:1236–1237.
Stubbs, P, Collinson PO, Moseley D, Greenwood T, Noble MIM. A prospective study of the role of cardiac troponin T in patients admitted with unstable angina. Brit Med J 1996;313:262–265.
Stubbs P, Collinson PO, Moseley, Greenwood T, Noble M. The prognostic significance of admission troponin T concentrations in patients with myocardial infarction. Circulation 1996;94:1291–1297.
Abbas SA, Green S, Wu A, et al. Serum cardiac troponin T measurements in unstable angina: An early, accurate marker of increased risk (abstr). J Am Coll Cardiol 1995;25:147–148.
Lindahl B, Venge P, Wallentin L. Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease. Circulation 1996;93:1651–1657.
Ohman EM, Armstrong PW, Christenson H, et al. Cardiac troponin T levels for risk stratification in acute myocardial infarction. N Engl J Med 1996;335:1333–1341.
Roberts R. The two out of three criteria for the diagnosis of infarction. Is it passé? Chest 1984;86:511–513.
Collinson, PO, Gerhardt W, Katus HA, et al. Multicentre evaluation of an immunological rapid test for the detection of troponin T in whole blood samples. Eur J Clin Chem Clin Biochem 1996;34:591–598.
Keffer JH. Myocardial markers of injury. Evolution and insights. Am J Clin Path 1996;105:305–320.
Wu AHB, Valdes R, Apple F, et al. Cardiac troponin-T immunoassay for diagnosis of acute myocardial infarction. Clin Chem 1994;40:900–907.
Mair J, Morandell Doris, Genser N, Lechleitner P, Dienstl F, Puschendorf B. Equivalent early sensitivities of myoglobin, creatine kinase MB mass, creatine kinase isoform ratios, and cardiac troponins I and T for acute myocardial infarction. Clin Chem 1995;41:1266–1272.
Müller Bardorff Margit, Hallermayer K, Schröder A, et al. Improved troponin T specific for the cardiac troponin T isoform. Clin Chem 1997, in press.
Li D, Jialal I, Keffer JH, Greater frequency of increased cardiac troponin T than increased troponin I in patients with chronic renal failure. Clin Chem 1996;42:114–115.
Hafner G, Thome-Kromer B, Schaube J, et al. Cardiac troponins in serum in chronic renal failure Clin Chem 1994;40:1790–1791.
Katus HA, Haller C, Müller-Bardorff Margit, Scheffold T, Remppis A. Cardiac troponin T in end-stage renal disease patients undergoing chronic maintenance hemodialysis (abstr) Clin Chem 1995;41–02–1203.
Collinson P, Stubbs P, Rosalki SB. Cardiac troponin T in renal disease (letter). Clin Chem 1995;41:1671–1673.
Baum H, Obst M, Huber U, Neumeier D. Cardiac troponin T in patients with high creatinine concentration but normal creatinine kinase activity in serum. Clin Chem 1996;42:474–475.
Parfrey PS. Cardiac and cerebrovascular disease in chronic uremia. Am J Kidney Dis 1993;21:77–80.
Kobayashi S, Tanaka M, Takamura N, et al. Serum cardiac troponin T in polymyositis and dermatomyositis (letter). Lancet 1993;342:1220–1222.
Bodor GS, Porterfield D, Vos EM, Smith S, Apple FS. Cardiac troponin-I is not expressed in fetal and healthy or diseased adult human skeletal muscle tissue. Clin Chem 1995;42:1710–1715.
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Gerhardt, W., Ljungdahl, L. Detection of Myocardial Damage by Serial Measurements of Cardiac Troponin T, CK MBmass, and TROPT Rapid Test. Cardiovasc Drugs Ther 11 (Suppl 1), 227–240 (1997). https://doi.org/10.1023/A:1007771311374
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DOI: https://doi.org/10.1023/A:1007771311374