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Biomedical subjects

C R Berger

Publications and source records attributed to C R Berger.

5 recordsLinked to original sources
PubMed1996

Early monitoring of serum cardiac troponin I for assessment of coronary reperfusion following thrombolytic therapy.

The authors report the use of cardiac troponin I (cTnI) for the early, noninvasive determination of coronary reperfusion following thrombolytic therapy. Cardiac troponin I, creatine kinase (CK)-MB, and myoglobin concentrations were measured in early serum specimens at 30, 60, and 90 minutes after initiation of therapy (0 minutes) in 25 consecutive patients given front-loaded rt-PA during acute myocardial infarction. Angiography, determined at 90 minutes after therapy, was used to classify patients as follows: group I (n = 17) reperfusion (TIMI flow grade 2, 3); and group 2 (n = 8) absence of reperfusion (TIMI flow grade 0, 1). The authors calculated the ratio increase in cTnI (delta cTnI), CK-MB (delta CK-MB), and myoglobin (delta myoglobin) 90 minutes after therapy in group 1 and 2. Serum cTnI, CK-MB and myoglobin concentrations significantly increased at 60 and 90 minutes in group 1, but not in group 2. Delta cTnI, delta CK-MB, and delta myoglobin levels were significantly increased in group 1 versus group 2 at 90 minutes. Further, delta cTnI was significantly greater at 90 minutes within group 1 compared to delta CK-MB and delta myoglobin. The sensitivity for detecting reperfusion at 90 minutes angiography using threshold values of 6.0 for delta cTnI, 7.0 for delta CK-MB, and 5.0 for delta myoglobin were: delta cTnI 82.4%; delta CK-MB 64.7%; delta myoglobin 76.5%; respectively. This study indicates that early serial measurements of cTnI were a more accurate predictor of early coronary artery reperfusion 90 minutes after thrombolytic therapy compared to CK-MB and myoglobin. Larger population studies will be necessary to confirm these finding.

Coronary Circulation↗
PubMed1995

Cardiac troponin, CK-MB and myoglobin for the early detection of acute myocardial infarction and monitoring of reperfusion following thrombolytic therapy.

It is important to establish as soon as possible whether patients who present with chest pain are having an acute myocardial infarction (AMI). Ideally, sensitive and specific serum myocardial markers could provide the basis for early detection as well as determine the status of reperfusion following thrombolytic therapy. The present study examined the utility of cardiac troponin I (cTnI), CK-MB, and myoglobin for the sensitive and specific detection of AMI in 98 consecutive patients presenting to the emergency department (ED) with chest pain. In addition, cardiac troponin T (cTnT), CK-MB, and myoglobin samples were measured over a 90 min time period following thrombolytic therapy in nine separate AMI patients to assess reperfusion. In the ED study, CK-MB, myoglobin, and cTnI were equally sensitive (100%) for the detection of AMI in patients who presented 7.4-14 h after onset of chest pain. However, cTnI was the most specific serum marker (specificity 91.9% compared to CK-MB 85.6%, myoglobin 61.4%). Five of the six non-related AMI patients who had an elevated cTnI had clinically documented myocardial involvement. In the reperfusion study, cTnT, CK-MB and myoglobin, relative increases were greater in reperfused compared to non-reperfused patients. Within the reperfused group, the relative increase of cTnT was greater than CK-MB and myoglobin at 90 min following thrombolytic therapy. These findings show the clinical utility of cardiac-specific troponins as markers for the early detection of AMI and monitoring of reperfusion following thrombolytic therapy.

Creatine Kinase↗
PubMed1994

Impact of the electrocardiogram on the delivery of thrombolytic therapy for acute myocardial infarction.

The initial electrocardiogram is crucial in accurately selecting patients with chest pain for thrombolytic therapy. An electrocardiogram with a large amount of ST-segment elevation and depression is "visually alarming," and therefore, may influence the efficiency of patient treatment with thrombolytic therapy. It was hypothesized that the amount of ST-segment deviation present on the initial electrocardiogram was an important variable in determining the time to initiation of thrombolysis in the emergency department. The time from arrival at the emergency department to thrombolysis was measured in 93 consecutive patients with suspected acute myocardial infarction (AMI) who were treated with intravenous thrombolytic therapy by emergency department physicians. This was correlated with the sum of ST-segment elevation and depression present on the initial electrocardiogram. AMI was proved in 83 patients (89%). In patients with proved AMI, the average time to thrombolysis was 50.8 +/- 25.6 minutes. Treatment began within the goal of < or = 30 minutes in 18 patients (22%) and was excessively delayed at > or = 60 minutes in 24 (29%). Regression analysis of multiple clinical variables revealed that ST-segment sum was the only variable that significantly influenced the time to thrombolysis (r = -0.42; p < 0.001). For patients treated in < or = 30 minutes, the average ST-segment sum was 21.1 +/- 13.5 vs 11.5 +/- 11.4 mm for those treated in > or = 60 minutes (p = 0.01). In 10 patients mistakenly treated with thrombolytic therapy, the electrocardiographic processes responsible for ST-segment elevation included the early repolarization variant, left ventricular hypertrophy, old anterior AMI with persistent ST-segment elevation, and conduction delay.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗