Hong Ji Yeon, Ryu Sung Kee, Park Ji Young, Park Sung Hun, Choi Jaewoong
Division of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
J Cardiovasc Imaging. 2021 Jul;29(3):228-233. doi: 10.4250/jcvi.2020.0167. Epub 2021 Feb 23.
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.
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.
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.
Follow-up changes in cardiac enzymes can be an effective early tool for differentiating SCMP from anterior STEMI.
大多数急性前壁ST段抬高型心肌梗死（STEMI）或应激性心肌病（SCMP）患者的心肌酶升高，且在24小时内达到峰值。心肌酶的变化模式可能是鉴别前壁STEMI和SCMP的早期线索。
本研究是在单一中心进行的回顾性分析（匹配病例和各自的对照对象）。我们比较了27例SCMP患者和30例前壁STEMI患者。我们使用了实验室数据，包括入院时的心脏标志物，如初始肌酸激酶同工酶MB（CK-MB）分数和肌钙蛋白T（Tn-T），以及随访时的CK-MB和Tn-T峰值。
平均年龄为69.3±14.1岁，38.6%的患者为女性。SCMP患者比前壁STEMI患者年龄更大，女性更多，左心室射血分数更低。前壁STEMI组的初始CK-MB高于SCMP组。相比之下，两组的初始Tn-T水平无显著差异。前壁STEMI组的CK-MB和Tn-T峰值水平以及相对于初始水平的变化显著大于SCMP组。基于CK-MB峰值>46.65 ng/mL或Tn-T>1.56 ng/mL可将SCMP与前壁STEMI区分开来。
心肌酶的随访变化可以作为鉴别SCMP和前壁STEMI的有效早期工具。
