Diagnostic and Prognostic Significance of Serum Transaminase Levels in Coronary Occlusive Disease

Abstract

Clinical and experimental studies of acute myocardial infarction suggest that serum glutamic oxalacetic transaminase (SGO-T) levels may have both diagnostic and prognostic significance. The authors report their experience in 255 patients hospitalized because of chest pain strongly suggestive of acute myocardial infarction. The results of serial determinations are compared with the clinical data and the electrocardiographic findings. The data indicate that abnormally high levels have both diagnostic and prognostic significance.CLINICAL and experimental studies of acute myocardial infarction1-7 have suggested that the serum glutamic oxalacetic transaminase (SGO-T) test devised by LaDue and his associates may have both diagnostic and prognostic significance. The present report contains data on 255 patients all of whom were hospitalized with chest pain strongly suggesting myocardial infarction in the differential diagnosis.These data indicate that the test is of diagnostic value, particularly in patients in whom the diagnosis cannot be made with certainty from the electrocardiographic findings and other clinical features. A study of the fatal cases suggests that the test also has prognostic significance. METHODSThe patients were all hospitalized either at the Wadsworth General Veterans Administration Hospital or at the UCLA Medical Center. All but 3 of the patients were men ranging in age from 37 to 85 years. Efforts were made to obtain serial SGO-T determinations, particularly during the first few days following the onset of pain, since the timeconcentration curve of the SGO-T levels has been shown to be far more informative than single ranFrom Wadsworth Veterans Administration Hospital and the UCLA Medical Center, Los Angeles, Calif.This work was supported by a grant from Los Angeles County Heart Association and in part from the Alfred Reschke-John Binnay Memorial Research Fund.Presented in part at the Annual Meeting of the American Heart Association, New Orleans, Louisiana, October 22-26, 1955. Abstracted, Circulation 12: 729, 1955. dom samples.3 Cases with only 1 determination were excluded from the study unless that sample was markedly elevated and appeared to be significantly related in time to the onset of pain or to the death of the patient.The SGO-T levels were determined by the method of Karmen8 with slight modifications as described earlier.3 Some batches of malic dehydrogenase required dilution of 1 to 10 in phosphate buffer rather than 1 to 25 as previously done.In order to assess the diagnostic value of the test the cases were divided into those with proved myocardial infarction and those in whom the diagnosis of myocardial infarction could not be made with certainty.The cases were considered to have proved infarction if the history was compatible with the diagnosis and the electrocardiograms showed pathologic Q waves and typical evolutionary ST and T-wave patterns of acute myocardial infarction; 111 cases fell into this group.

Serum Transaminase Determinations as a Diagnostic Aid in Myocardial Infarction

“…The Chart illustrates the curve obtained in two typical cases when the serum transaminase is plotted against time. These time relationships agree closely with those reported by La and by Kattus et al (1956). The test is most useful in myocardial infarction if a sample can be obtained within a few hours after the onset.…”

“…Thus to the well-established criteria of clinical history and examination, together with the changes in the electrocardiogram, blood sedimentation rate, white-cell count, temperature chart, and urobilinogen excretion, a new biochemical test has been added which helps to determine whether or not recent myocardial infarction has occurred. Since that time several other reports describing increased serum transaminase activity following myocarcfial infarction have been published (Chinsky et al, 1956;Kattus et al, 1956;Merrill et al, 1956).…”

Cardiovascular Diseases (Medical)

“…Numerous studies attest to the value of transaminase determination in the recognition of acute myocardial infarction, especially if the level is over 100 units (21,22). Walsh et al (23) have found that pulmonary infarc tion and pneumonia can also produce levels as high, but the rise tends to be slower.…”

The non-cardiac use and significance of cardiac troponins

“…In the 1950s, it was noted that certain transaminases were released from dying myocytes and that they could in turn be detected in the laboratory with potential clinical significance for the diagnosis of MI. [1][2][3] This initiated the contest to develop biochemical markers of myocardial damage and to determine their prognostic value. Early markers developed included AST, lactate dehydrogenase (LDH), and the improved creatine kinase (CK) assay in the 1960 s. 4 However, despite the advances, these tests were still limited by specificity to cardiac tissue and a stride forward was made with CK isoenzymes, particularly the MB fraction in 1966.…”