Comparison of Troponin-T With Other Cardiac Markers in a VA Hospital

Abstract

Measuring protein markers of cardiac damage is important for the diagnosis of myocardial infarction (MI). This study accessed the positive and negative predictive values of cardiac markers for detecting MI and perioperative Ml in cardiac surgery by evaluating: creatine kinase (CK); creatine kinase MB isoenzyme mass assay (CK-MB); lactate dehydrogenase (LDH); lactate dehydrogenase isoenzyme-1 (LDH-1); myoglobin; and cardiac troponin T (cTnT) in a Veterans Affairs Medical Center. Inclusion criterion was any patient who had a CK ordered over a 6-month period. Patient history and diagnosis were obtained from discharge summaries. The two groups of patients studied either presented with symptoms of MI (n -370), or underwent open heart surgery (n = 63). In the patients evaluated for MI, there were 433 susProtein markers of cardiac damage play an important role in the diagnosis of myocardial infarctions, yet all have limitations. Elevations of creatine kinase (CK) and its isoenzyme creatine kinase-MB (CK-MB) provide evidence for myocardial infarctions (Mis); however, misdiagnosis occurs in some patients due to the lack of cardiac specificity of these enzymes. Other problems associated with CK include the 6 to 8 hours required for elevation above normal and the relatively short diagnostic window of 2 to 3 days. Due to these restrictions, myoglobin and lactate dehydrogenase (LDH) have been used in conjunction with CK-MB. 1Myoglobin and LDH complement CK-MB by extending the diagnostic window. Myoglobin is a low molecular weight cytosolic protein that appears in blood soon after tissue injury.2 The release of LDH from the myocardium lags that of CK-MB and is most useful 48 to 72 hours postinjury. Both myoglobin and LDH are present in other tissue besides the heart that limits their specificity. Monitoring lactate dehydrogenase isoenzyme-1 (LDH-

A comparative study on the immunohistochemical detection of early myocardial damage

“…Other markers such as myoglobin, desmin, fibrinogen and fibronectin, have been investigated by various authors (Brinkmann et al 1993;Amberg 1995). The early postischemic detection of cardiac proteins in serum, especially troponin (Fitzgerald et al 1996) and the heart-type fatty acid binding protein FABP (Kleine et al 1992;Glatz et al 1994) suggests that these proteins are more suitable than heart-type creatine kinase. Troponin is a contractile protein which comprises 5% of muscle proteins and has three subunits which consist of a globular end and a rod.…”

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

“…These results are comparable with other studies: A study on comparison of Troponin-T with other cardiac markers. They found that cardiac marker sensitivities and specificities were cTnT (98% and 73%), CK-MB mass (81% and 97%), CK (73% and 78%), LDH (67% and 80%), LDH-1 (33% and 95%), and myoglobin (79% and 66%) [20].…”