Pathophysiological Analysis of Serum Troponin T Release Kinetics in Evolving Ischemic Myocardial Injury
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概要
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The present study measured cardiac troponin T(TnT)for the pathophysiological analysis of evolving ischemic myocardial injury in 35 patients with unstable angina(3: Class IB, 32: Class IIIB)and in 40 patients undergoing coronary reperfusion therapy for acute myocardial infarction. Serum TnT, creatine kinase(CK), CKMB, myoglobin(Mb), and myosin light chain 1(MLC1)were measured every 2-24h for 10 days after admission to the CCU. In patients with unstable angina, positive test results were detected in 65.7% for TnT, 20% for CK, 37.1% for CKMB, 60.9% for Mb, and 26% for MLC1. Of the 23 patients with positive TnT, 12(52.2%)had cardiac events. Of the 12 patients with negative TnT, 11(91.6%)were event-free. All of the patients who developed cardiac events showed a persistent(n=10)or delayed elevation(n=2)pattern 28-120 h beforehand. The sensitivity for predicting cardiac events was 92.3% for TnT, 80% for Mb, 53.8% for CKMB, and 50% for MLC1. In patients with acute myocardial infarction, TnT release kinetics showed 2 peaks after coronary reperfusion therapy. TnT values at the 1st peak significantly correlated with maximum CKMB(r=0.70, p<0.05)and early-stage left ventricular wall motion score(r=0.60, p<0.05), while 2nd-peak TnT values significantly correlated with maximum MLC1(r=0.59, p<0.05), the T1-SPECT score(r=0.78, p<0.05)and left ventricular ejection fraction(r=-0.74, p<0.05)in the convalescent stage. The 2nd/1st-peak TnT ratio significantly correlated with the nQ/nST elevation index(ratio of the number of leads developing abnormal Q-wave 1 week after the onset to the number of leads showing ST elevation of more than 1 mm at admission)(r=0.63, p<0.05)in patients with anterior myocardial infarction. These data indicate that persistent release of TnT reflects progressive irreversible myocardial damage in unstable angina and indicates a risk of future cardiac events. In acute myocardial infarction, the 2nd/1st-peak TnT ratio in patients undergoing coronary reperfusion therapy may be useful for the quantitative evaluation of myocardial salvage.
- 社団法人日本循環器学会の論文
- 1996-04-20
著者
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TAKANO Teruo
Department of Internal Medicine, Nippon Medical School
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Setsuta Kouichi
Department Of Cardiology Tokyo Women's Medical University
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Setsuta Koichi
Department of Cardiology and Clinical Laboratory, Tokyo Metropolitan Komagome Hospital
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Kanazawa Hiromi
日本医科大学 内科学第一
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Kishida H
Department Of Internal Medicine Division Of Cardiology Nippon Medical School
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Kishida Hiroshi
日本医科大学 循環器内科
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Tomita Yoshifumi
Intensive And Cardiac Care Unit Nippon Medical School
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Tokita Yukichi
Department Of Internal Medicine And Cardiology Nippon Medical School Tama-nagayama Hospital
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Tokita Yukichi
Intensive And Cardiac Care Unit Nippon Medical School
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Hayakawa Hirokazu
The First Department Of Medicine Nippon Medical School
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Hayakawa Hirokazu
Internal Medicine Department Of Cardiology Nippon Medical School
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Hayakawa Hirokazu
The First Department Of Internal Medicine Nippon Medical School
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Hayakawa Hirokazu
Department Of Physiological Laboratory Nippon Medical School
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Seino Yoshihiko
Department Of Internal Medicine Chiba-hokusoh Hospital Nippon Medical School
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Kishida Hiroshi
Department Of Internal Medicine Division Of Cardiology Nippon Medical School
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Tomita Yoshifumi
Department Of Internal Medicine And Cardiology Nippon Medical School Tama-nagayama Hospital
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Setsuta Koichi
Department Of Cardiology Tokyo Women's Medical University
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Takano Teruo
Department Of 1st. Internal Medicine Nippon Medical School
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Kishida Hiroshi
Department Of Cardiology Nippon Medical School Tama-nagayama Hospital
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Hoshino Kimihiko
Department of Internal Medicine and Coronary Care Unit, Nippon Medical School
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Setsuta Koichi
Department Of Cardiology And Clinical Laboratory
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Seino Yoshihiko
Department Of Cardiovascular Medicine Osaka University Graduate School Of Medicine
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Hoshino Kimihiko
First Department Of Internal Medicine Nippon Medical School
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Hayakawa Hirokazu
The 1st Department Of Internal Medicine Nippon Medical School
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Tomita Yoshifumi
Department Of Cardiology Tamanagayama Hospital Nippon Medical School
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Hayakawa Hirokazu
Department Of Cardiology Nippon Medical School
-
Kishida Hiroshi
日本医科大学 内科学循環器
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Kishida Hioroshi
1st Department Of Internal Medicine Nippon Medical School
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Tokita Yukichi
Division Of Cardiology Tohsei National Hospital
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Kishida Hiroshi
Division Of Cardiology Hepatology Geriatrics And Integrated Medicine Department Of Internal Medicine
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Kishida Hiroshi
First Dept.of Intern. Med. Nippon Medical School
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Tomita Yoshifumi
Division Of Cardiology Tohsei National Hospital
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Seino Yoshihiko
Department Of Cardiology Chiba-hokuso Hospital
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Kishida Hiroshi
Division Of Cardiology Hepatology Geriatrics And Integrated Medicine Department Of Internal Medicine
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Honma Hiroshi
Division Of Cardiology Hepatology Geriatrics And Integrated Medicine Department Of Internal Medicine
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Hayakawa Hirokazu
First Dept Of Internal Medicine Nippon Medical School
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Tomita Yoshifumi
Division Of Ccu And Icu Nippon Medical School
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