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ARTICLE |

Can We Clinically Measure Infarction Size? FREE

Robert Roberts, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association, edited by C. Richard Conti, MD.

Reprint requests to Cardiac Care Unit, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110 (Dr Roberts).


JAMA. 1979;242(2):183-185. doi:10.1001/jama.1979.03300020053032
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SINCE the advent of the coronary care unit (CCU) in 1962, the in-hospital mortality of patients with acute myocardial infarction has been notably reduced, predominantly because of better management of ventricular arrhythmias. Despite adequate antiarrhythmic therapy, there remains a 15% to 25% acute mortality that is related primarily to pump failure, a major determinant of which is the extent of myocardial damage (infarct size).

Postmortem studies have shown that patients dying of cardiogenic shock exhibit 40% or more destruction of the myocardium. Clearly, therapeutic efforts in the modern CCU must be directed toward reducing the extent of myocardial damage associated with myocardial infarction. Pioneering studies by Braunwald and others1 suggested that the development of myocardial damage is a dynamic event that can be favorably altered, notably by decreasing the imbalance between myocardial oxygen supply and demand. This provided the impetus for an area of research, namely, protection of ischemic myocardium,

REFERENCES

Maroko PR, Kjekshus JK, Sobel BE, et al:  Factors influencing infarct size following experimental coronary artery occlusion . Circulation 43:67-82, 1971;.
Sobel BE, Bresnahan GF, Shell WE, et al:  Estimation of infarct size in man and its relation to prognosis . Circulation 46:640-648, 1972;.
Roberts R, Sobel BE:  Creatine kinase isoenzymes in the assessment of heart disease . Am Heart J 95:521-528, 1978;.
Roberts R, Henry PD, Sobel BE:  An improved basis for enzymatic estimation of infarct size . Circulation 52:743-754, 1975;.
Vatner SF, Biag H, Manders WT, et al:  Effects of coronary artery reperfusion on myocardial infarct size calculated from creatine kinase . J Clin Invest 61:1048-1056, 1978;.
Rogers WJ, McDaniel HG, Smith LR, et al:  Correlation of CPK-MB and angiographic estimates of infarct size in man , abstracted. Circulation 54( (suppl 2) ):28, 1976;.
Bleifeld W, Mathey D, Hanrath P, et al:  Infarct size estimated from serial serum creatine phosphokinase in relation to left ventricular hemodynamics . Circulation 55:303-311, 1977;.
Roberts R, Husain A, Ambos HD, et al:  Relation between infarct size and ventricular arrhythmia . Br Heart J 37:1169-1175, 1975;.
Klein MS, Roberts R, Coleman RE:  Radionuclides in the assessment of myocardial infarction . Am Heart J 95:659-667, 1978;.
Buja ML, Parkey RW, Dees JH, et al:  Morphologic correlates of technetium-99m stannous pyrophosphate imaging of acute myocardial infarcts in dogs . Circulation 52:596-607, 1975;.
Weiss ES, Siegel BA, Sobel BE, et al:  Evaluation of myocardial metabolism and perfusion with positron-emitting radionuclides . Prog Cardiovasc Dis 20:191-206, 1977;.

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Maroko PR, Kjekshus JK, Sobel BE, et al:  Factors influencing infarct size following experimental coronary artery occlusion . Circulation 43:67-82, 1971;.
Sobel BE, Bresnahan GF, Shell WE, et al:  Estimation of infarct size in man and its relation to prognosis . Circulation 46:640-648, 1972;.
Roberts R, Sobel BE:  Creatine kinase isoenzymes in the assessment of heart disease . Am Heart J 95:521-528, 1978;.
Roberts R, Henry PD, Sobel BE:  An improved basis for enzymatic estimation of infarct size . Circulation 52:743-754, 1975;.
Vatner SF, Biag H, Manders WT, et al:  Effects of coronary artery reperfusion on myocardial infarct size calculated from creatine kinase . J Clin Invest 61:1048-1056, 1978;.
Rogers WJ, McDaniel HG, Smith LR, et al:  Correlation of CPK-MB and angiographic estimates of infarct size in man , abstracted. Circulation 54( (suppl 2) ):28, 1976;.
Bleifeld W, Mathey D, Hanrath P, et al:  Infarct size estimated from serial serum creatine phosphokinase in relation to left ventricular hemodynamics . Circulation 55:303-311, 1977;.
Roberts R, Husain A, Ambos HD, et al:  Relation between infarct size and ventricular arrhythmia . Br Heart J 37:1169-1175, 1975;.
Klein MS, Roberts R, Coleman RE:  Radionuclides in the assessment of myocardial infarction . Am Heart J 95:659-667, 1978;.
Buja ML, Parkey RW, Dees JH, et al:  Morphologic correlates of technetium-99m stannous pyrophosphate imaging of acute myocardial infarcts in dogs . Circulation 52:596-607, 1975;.
Weiss ES, Siegel BA, Sobel BE, et al:  Evaluation of myocardial metabolism and perfusion with positron-emitting radionuclides . Prog Cardiovasc Dis 20:191-206, 1977;.
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