Circulation, Vol 88, 101-106, Copyright © 1993 by American Heart Association
JE Adams 3d, GS Bodor, VG Davila-Roman, JA Delmez, FS Apple, JH Ladenson and AS Jaffe
BACKGROUND. Levels of MBCK can be increased in patients with skeletal
muscle injury or renal failure in the absence of myocardial injury, causing
diagnostic confusion. This study was designed to determine whether
measurement of cardiac troponin I (cTnI), a myocardial regulatory protein
with comparable sensitivity to MBCK, has sufficient specificity to clarify
the etiology of MBCK elevations in patients with acute or chronic skeletal
muscle disease or renal failure. METHODS AND RESULTS. Of the patients (n =
215) studied, 37 had acute skeletal muscle injury, 10 had chronic muscle
disease, nine were marathon runners, and 159 were chronic dialysis
patients. Patients were evaluated clinically, by ECG, and by
two-dimensional echocardiography. Total creatine kinase (normal, < 170
IU/L) was determined spectrophotometrically, and cTnI (normal, < 3.1
ng/mL) and MBCK (normal, < 6.7 ng/mL) were determined with specific
monoclonal antibodies. Values above the upper reference limit were
considered "elevated." Elevations of total creatine kinase were common, and
elevations of MBCK occurred in 59% of patients with acute muscle injury,
78% of patients with chronic muscle disease and marathon runners, and 3.8%
of patients with chronic renal failure. Some of the patients were
critically ill; five patients were found to have had myocardial infarctions
and one had a myocardial contusion. cTnI was elevated only in these
patients. CONCLUSIONS. Elevations of cTnI are highly specific for
myocardial injury. Use of cTnI should facilitate distinguishing whether
elevations of MBCK are due to myocardial or skeletal muscle injury.
ARTICLES
Cardiac troponin I. A marker with high specificity for cardiac injury
Cardiovascular Division, Washington University School of Medicine, St Louis, MO 63110.
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