title: Multiparametric approach to diagnosis of non-Q-wave acute myocardial infarction.
abstract: The present study investigated whether the lack of enzyme increase is reason enough to exclude necrosis in patients with ischemic heart disease who develop electrocardiographic sustained ST-T changes in the absence of Q waves. In 15 consecutive patients with angina who developed sustained ST-T changes during hospitalization, the presence of myocardial necrosis was investigated by a prospective multiparametric approach. Serum enzymes and myoglobin, pyrophosphate uptake, 2-dimensional echocardiography, perfusion scintigraphy, left ventriculography and coronary angiography were evaluated. According to creatine kinase and creatine kinase-MB peak at twice the upper normal value, the diagnosis of acute myocardial infarction applied only to 40% of patients. However, myoglobin was positive in 80% and a perfusion defect could be documented by an electrocardiographic gated microsphere technique in 100% of patients. The positivity of myoglobin increased to 100% and of creatine kinase and creatine kinase-MB to 87 and 60%, respectively, when a peak value twice the individual lowest value was considered for positivity. The 100% presence of perfusion defects associated with the high prevalence of both positive pyrophosphate uptake (87%) and regional dyssynergies (87 and 73%, respectively, by left ventriculography and echocardiography) strongly suggest that sustained (greater than or equal to 7 days) ST-T changes in this population were indicative of myocardial necrosis. Thus, by conventional enzymatic approach, diagnosis of non-Q-wave infarction can be missed in a sizable number of patients and present important clinical implications.
authors.affiliation: Institute of Clinical Physiology, National Research Council, Pisa University, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Carpeggiani
authors.forename: A
authors.initials: A
authors.lastname: L'Abbate
authors.forename: P
authors.initials: P
authors.lastname: Marzullo
authors.forename: G
authors.initials: G
authors.lastname: Buzzigoli
authors.forename: O
authors.initials: O
authors.lastname: Parodi
authors.forename: G
authors.initials: G
authors.lastname: Sambuceti
authors.forename: C
authors.initials: C
authors.lastname: Marcassa
authors.forename: C
authors.initials: C
authors.lastname: Boni
authors.forename: E
authors.initials: E
authors.lastname: Moscarelli
authors.forename: A
authors.initials: A
authors.lastname: Distante
mesh_terms: D000328:Adult; D000368:Aged; D003402:Creatine Kinase / Q000378:metabolism; D011756:Diphosphates; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000201:enzymology / Q000503:physiopathology; D013667:Technetium; D016698:Technetium Tc 99m Pyrophosphate
chemical_list: D011756:Diphosphates; D016698:Technetium Tc 99m Pyrophosphate; D013667:Technetium; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase