Arch Intern Med —, Shell WE, Kjekshus JK, Sobel BE: Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial changes in serum creatine phosphokinase activity. J Clin Invest —, Circulation 67—81, Eur Heart J 4: 20—25, N Engl J Med —, Strauss HD, Sobel BE, Roberts R: The influence of occult right ventricular infarction on enzymatically estimated infarct size, hemodynamics and prognosis.
In preparation. Rentrop P, Blanke H, Karsch KR, et al: Changes in left ventricular function after intracoronary streptokinase infusion in clinically evolving myocardial infarction. Markis JE, Malagold M, Parker JA, et al: Myocardial salvage after intracoronary thrombolysis with streptokinase in acute myocardial infarction: assessment by intracoronary thallium J Clin Invest , Jarmakani JM, Limbird L, Graham TC, et al: Effects of reperfusion on myocardial infarct, and the accuracy of estimating infarct size from serum creatine phosphokinase in the dog.
Cardiovasc Res , Ganz W, Geft I: What is the role of thrombolytic therapy in acute myocardial infarction? Cardiovasc Clin —, JACC 3: —, Am J Cardiol 82—86, Baltimore: University Park Press, , pp — Richard D. Wagner There are no affiliations available. Personalised recommendations. In the event of myocardial damage, the unbound troponin is first released [22] [23]. The rest of the troponin, which is bound to the actin, is released slowly with structural damage and results in the prolonged duration of elevated troponins in the plasma.
Troponin concentration begins to rise 4 to 6 hours after onset of symptoms, peaks by about 18 to 24 hours, and remains in the detectable levels for 72 to 96 hours. Troponin is more specific to the cardiac muscle when compared to CKMB, and current assays for troponin are more sensitive and specific than the assays for CK-MB measurement.
Given the expression of CK-MB in skeletal muscle and the presence of evidence proving the failure of CK-MB relative index and several other non-AMI causes of CK-MB elevation, troponin has been proven as the biomarker of choice for the detection of myocardial damage of any etiology. Troponin remains in circulation for a longer duration when compared to CK-MB.
However, after the advent of troponin and the current aggressive interventional approach to AMI, and due to lack of literature comparing CK-MB against troponin in the diagnosis of reinfarction, the use of CK-MB has declined. Given the significant number of studies and guidelines from the American College of Cardiology recommending the use of troponin for the diagnosis and ruling out of acute coronary syndromes instead of CK-MB, decreasing the use of CK-MB in hospital and outpatient setting requires an interprofessional team of healthcare professionals that includes a nurse, laboratory technologists, pharmacist and several physicians in different specialties especially cardiologists and cardiothoracic surgeons.
Specialty-trained nurses are involved in the ordering and interpretation of this test. Clinica chimica acta; international journal of clinical chemistry. Biochemical and biophysical research communications. Recommendations based on a quantitative analysis. Annals of internal medicine. Clinical chemistry. Circulation research. Karlsberg RP,Roberts R, Effect of altered thyroid function on plasma creatine kinase clearance in the dog.
The American journal of physiology. Biochimica et biophysica acta. The Journal of laboratory and clinical medicine. Basic research in cardiology. British heart journal. Coron Artery Dis. Mueller C ; Use of high-sensitivity troponin for the diagnosis of acute myocardial infarction. BMC Med. McCord J ; Will high-sensitivity troponin assays lead to improved outcomes in patients with acute coronary syndrome? Clin Chim Acta.
Bassan R, Tura BR, Maisel AS ; B-type natriuretic peptide: a strong predictor of early and late mortality in patients with acute chest pain without ST-segment elevation in the emergency department. He thought Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions.
Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions. This article is for Medical Professionals. In this article Indications for measurement of cardiac enzymes Troponins T and I Creatine kinase Myoglobin levels Natriuretic peptides Other findings Future developments.
Cardiac troponins T and I are the preferred markers for myocardial injury as they have the highest sensitivities and specificities for the diagnosis of acute myocardial infarction [ 1 ].
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