(Circulation. 1995;92:2848-2854.)
© 1995 American Heart Association, Inc.
Articles |
Discrimination Between Myocardial and Skeletal Muscle Injury by Assessment of the Plasma Ratio of Myoglobin Over Fatty Acid–Binding Protein
From the Departments of Physiology (F.A.V.N., K.W.H.W., J.F.C.G.) and Motion Sciences (G.J.V.D.V.), University of Limburg; the Cardiovascular Research Institute Maastricht (CARIM) (A.H.K., W.T.H.); the Departments of Cardiothoracic Surgery (J.G.M.), Anesthesiology (C.D.P.), and Clinical Chemistry (K.W.H.W., M.P.V.D.), Academic Hospital Maastricht; and the Department of Cardiology (H.A.K.), De Wever Hospital, Heerlen, The Netherlands.
Correspondence to J.F.C. Glatz, PhD, Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), University of Limburg, PO Box 616, 6200 MD Maastricht, The Netherlands.
Background Myoglobin and fatty acid–binding protein (FABP) each are useful as early biochemical markers of muscle injury. We studied whether the ratio of myoglobin over FABP in plasma can be used to distinguish myocardial from skeletal muscle injury.
Methods and Results Myoglobin and FABP were assayed
immunochemically in tissue samples of human heart and skeletal muscle
and in serial plasma samples from 22 patients with acute myocardial
infarction (AMI), from 9 patients undergoing aortic surgery (causing
injury of skeletal muscles), and from 10 patients undergoing cardiac
surgery. In human heart tissue, the myoglobin/FABP ratio was 4.5 and in
skeletal muscles varied from 21 to 73. After AMI, the plasma
concentrations of both proteins were elevated between 
1 and 15 to 20
hours after the onset of symptoms. In this period, the myoglobin/FABP
ratio was constant both in subgroups of patients receiving and those
not receiving thrombolytics and amounted to 5.3±1.2 (SD).
In serum from aortic surgery patients, both proteins were elevated
between 6 and 24 hours after surgery; the myoglobin/FABP ratio was
45±22 (SD), which is significantly different from plasma values in AMI
patients (P<.001). In patients with cardiac surgery, the
ratio increased from 11.3±4.7 to 32.1±13.6 (SD) during 24 hours
after
surgery, indicating more rapid release of protein from injured
myocardium than from skeletal muscles.
Conclusions The ratio of the concentrations of myoglobin over FABP in plasma from patients with muscle injury reflects the ratio found in the affected tissue. Since this ratio is different between heart (4.5) and skeletal muscle (20 to 70), its assessment in plasma allows the discrimination between myocardial and skeletal muscle injury in humans.
Key Words: myoglobin • fatty acids • myocardial infarction • aorta • surgery
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