Early Differentiation of Stress Cardiomyopathy from Acute Anterior Wall Myocardial Using Changing Cardiac Enzyme Patterns
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BACKGROUND: Most patients with acute anterior wall ST elevation myocardial infarction (STEMI) or stress cardiomyopathy (SCMP) show elevations in cardiac enzymes that peak within 24 hours. The changing pattern of cardiac enzymes can be an early clue to the differentiation of anterior STEMI and SCMP. METHODS: This study was a retrospective analysis (matching cases and respective control subjects) performed at a single center. We compared 27 patients with SCMP and 30 patients with anterior STEMI. We used laboratory data included cardiac marker, such as the initial creatine kinase MB (CK-MB) fraction and troponin T (Tn-T), at admission and peak CK-MB and Tn-T at follow up. RESULTS: The mean age was 69.3 ± 14.1 years, and 38.6% of patients were female. The SCMP patients were older, more often female, and had lower left ventricular ejection fractions than the anterior STEMI patients. The initial CK-MB was higher in the anterior STEMI group than in the SCMP group. In contrast, the initial Tn-T level was not significantly different between the 2 groups. Peak CK-MB and Tn-T levels and change from initial levels were significantly greater in the anterior STEMI group than they were in the SCMP group. SCMP could be differentiated from anterior STEMI based on peak CK-MB > 46.65 ng/mL or Tn-T > 1.56 ng/mL. CONCLUSIONS: Follow-up changes in cardiac enzymes can be an effective early tool for differentiating SCMP from anterior STEMI.
Abstract
BACKGROUND: Most patients with acute anterior wall ST elevation myocardial infarction (STEMI) or stress cardiomyopathy (SCMP) show elevations in cardiac enzymes that peak within 24 hours. The changing pattern of cardiac enzymes can be an early clue to the differentiation of anterior STEMI and SCMP. METHODS: This study was a retrospective analysis (matching cases and respective control subjects) performed at a single center. We compared 27 patients with SCMP and 30 patients with anterior STEMI. We used laboratory data included cardiac marker, such as the initial creatine kinase MB (CK-MB) fraction and troponin T (Tn-T), at admission and peak CK-MB and Tn-T at follow up. RESULTS: The mean age was 69.3 ± 14.1 years, and 38.6% of patients were female. The SCMP patients were older, more often female, and had lower left ventricular ejection fractions than the anterior STEMI patients. The initial CK-MB was higher in the anterior STEMI group than in the SCMP group. In contrast, the initial Tn-T level was not significantly different between the 2 groups. Peak CK-MB and Tn-T levels and change from initial levels were significantly greater in the anterior STEMI group than they were in the SCMP group. SCMP could be differentiated from anterior STEMI based on peak CK-MB > 46.65 ng/mL or Tn-T > 1.56 ng/mL. CONCLUSIONS: Follow-up changes in cardiac enzymes can be an effective early tool for differentiating SCMP from anterior STEMI.
참고문헌 (12)
- Satoh H, "Clinical Aspect of Myocardial Injury: from Ischemia to Heart Failure", pp.56~64 (1990), Kagakuhyouronsha
- Wedekind H, "Tako-tsubo cardiomyopathy. Incidence in patients with acute coronary syndrome", Herz, 31, pp.339~346 (2006)
- Azzarelli S, "Clinical features of transient left ventricular apical ballooning", Am J Cardiol, 98, pp.1273~1276 (2006)
- Prasad A, "Apical ballooning syndrome(Tako-Tsubo or stress cardiomyopathy) : a mimic of acute myocardial infarction", Am Heart J, 155, pp.408~417 (2008)
- Alpert JS, "Myocardial infarction redefined--a consensus document of the Joint European Society of Cardiology", American College of Cardiology Committee for the redefinition of myocardial infarction, 2000, pp.36, 959~969
- Doyen D, "Cardiac biomarkers in Takotsubo cardiomyopathy", Int J Cardiol, 174, pp.798~801 (2014)
- Lyon AR, "Current state of knowledge on Takotsubo syndrome : a position statement from the taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology", Eur J Heart Fail, 18, pp.8~27 (2016)
- Tibrewala A, "Importance of temporal changes in myocardial strain in Takotsubo cardiomyopathy", BMJ Case Rep, 2017 (2017)
- Gopalakrishnan P, "Takotsubo cardiomyopathy : pathophysiology and role of cardiac biomarkers in differential diagnosis", World J Cardiol, 9, pp.723~730 (2017)
- Ramaraj R, "Levels of troponin release can aid in the early exclusion of stress-induced(takotsubo)cardiomyopathy", Exp Clin Cardiol, 14, pp.6~8 (2009)
- Templin C, "Clinical features and outcomes of takotsubo(stress)cardiomyopathy", N Engl J Med, 373, pp.929~938 (2015)
- Gorenek B, "Correlation between left ventricular ejection fraction and cardiac troponin T concentration is more pronounced in patients with nonischemic cardiomyopathy", J Electrocardiol, 40, pp.S75~ (2007)