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Size estimation of acute myocardial infarction from serial serum myoglobin observations with due consideration of individual differences in basic kinetics 

Authors: Torgny Groth a;  Mikael Hakman a; Christer Sylveacuten b
Affiliations:   a Unit for Biomedical Systems Analysis, Uppsala University,
b Departments of Internal Medicine and Clinical Chemistry, Karolinska Hospital, Sweden
DOI: 10.3109/00365518409083789
Publication Frequency: 8 issues per year
Published in: journal Scandinavian Journal of Clinical and Laboratory Investigation, Volume 44, Issue 1 February 1984 , pages 65 - 78
Formats available: PDF (English)
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Abstract

Thirty-three consecutive patients suffering from acute myocardial infarction were studied. Serial serum myoglobin and CK-MB measurements were made, and in seven patients individual kinetic constants for myoglobin were available from previous single injection studies. A two-compartment model for myoglobin kinetics was used for infarct size estimation. Given values for the basic kinetic constants (elimination rate constant, exchange rate constants, and distribution volume), the adjustment of a flexible, parameterized 'blood-appearance rate-function', OslashAMI, (mg·h-1), allowed estimation of start-time (t0), peak-time (tpeak) and end-time (tend) of myoglobin inflow into blood from the infarct area, in addition to the total cumulative release (A), which was used as a measure of infarct size.

Use of patient-mean values for the kinetic constants caused a mean difference in estimated 'infarct size' of 34% (n = 7). Individual estimation of the elimination rate constant from the 'final slope' of the serum myoglobin curve could neither be recommended from a theoretical point of view nor from the practical outcome of numerical calculations; the 'true' elimination rate constant is underestimated by a factor of about 10 on average.

Good correlation was found between our myoglobin estimates of 'infarct size' (using patient-mean kinetic constants), and independent estimates from serial serum CK-MB data, as calculated by the use of the method by Sobel et al.

Large inter-individual variations were found in the estimated infarct parameters, a circumstance which is of special interest in evaluation of therapeutic intervention studies on AMI-patients, and in infarct size prediction calculations.
Keywords: acute myocardial infarction; CK-MB; infarct parameters; myoglobin; two-compartment model
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