Multiparametric approach to diagnosis of non-Q-wave acute myocardial infarction

Journal Article · Wed Feb 15 04:00:00 EST 1989 · Am. J. Cardiol.; (United States)

DOI:https://doi.org/10.1016/0002-9149(89)90308-1· OSTI ID:6217624

Carpeggiani, C; L'Abbate, A; Marzullo, P; Buzzigoli, G; Parodi, O; Sambuceti, G; Marcassa, C; Boni, C; Moscarelli, E; Distante, A

The present study investigated whether the lack of enzyme increase is reason enough to exclude necrosis in patients with ischemic heart disease who develop electrocardiographic sustained ST-T changes in the absence of Q waves. In 15 consecutive patients with angina who developed sustained ST-T changes during hospitalization, the presence of myocardial necrosis was investigated by a prospective multiparametric approach. Serum enzymes and myoglobin, pyrophosphate uptake, 2-dimensional echocardiography, perfusion scintigraphy, left ventriculography and coronary angiography were evaluated. According to creatine kinase and creatine kinase-MB peak at twice the upper normal value, the diagnosis of acute myocardial infarction applied only to 40% of patients. However, myoglobin was positive in 80% and a perfusion defect could be documented by an electrocardiographic gated microsphere technique in 100% of patients. The positivity of myoglobin increased to 100% and of creatine kinase and creatine kinase-MB to 87 and 60%, respectively, when a peak value twice the individual lowest value was considered for positivity. The 100% presence of perfusion defects associated with the high prevalence of both positive pyrophosphate uptake (87%) and regional dyssynergies (87 and 73%, respectively, by left ventriculography and echocardiography) strongly suggest that sustained (greater than or equal to 7 days) ST-T changes in this population were indicative of myocardial necrosis. Thus, by conventional enzymatic approach, diagnosis of non-Q-wave infarction can be missed in a sizable number of patients and present important clinical implications.

• Research Organization: Pisa Univ. (Italy)
• OSTI ID: 6217624
• Journal Information: Am. J. Cardiol.; (United States), Journal Name: Am. J. Cardiol.; (United States) Vol. 63:7; ISSN AJCDA
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
BIOMEDICAL RADIOGRAPHY
BIOSYNTHESIS
BODY
CARBOXYLIC ACIDS
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
COUNTING TECHNIQUES
DIAGNOSIS
DIAGNOSTIC TECHNIQUES
DIAGRAMS
DISEASES
ELECTROCARDIOGRAMS
ENZYMES
GLOBIN
HEART
HETEROCYCLIC ACIDS
HETEROCYCLIC COMPOUNDS
ISOTOPES
MEDICINE
MUSCLES
MYOCARDIAL INFARCTION
MYOCARDIUM
MYOGLOBIN
NECROSIS
NUCLEAR MEDICINE
ORGANIC ACIDS
ORGANIC COMPOUNDS
ORGANIC NITROGEN COMPOUNDS
ORGANS
OXYGEN COMPOUNDS
PAIN
PATHOLOGICAL CHANGES
PATIENTS
PHOSPHORUS COMPOUNDS
PHOSPHORUS-GROUP TRANSFERASES
PHOSPHOTRANSFERASES
PIGMENTS
PORPHYRINS
PROTEINS
PYROPHOSPHATES
RADIOISOTOPE SCANNING
RADIOLOGY
SCINTISCANNING
SYMPTOMS
SYNTHESIS
TECHNETIUM ISOTOPES
TRANSFERASES