A Marker With High Specificity for Cardiac Injury

Background. Levels of MBCK can be increased in patients with skeletal muscle injury or renal failure in the absence of myocardial injury, causing diagnostic confusion. This study was designed to determine whether measurement of cardiac troponin I (cTnI), a myocardial regulatory protein with comparable sensitivity to MBCK, has sufficient specificity to clarify the etiology ofMBCK elevations in patients with acute or chronic skeletal muscle disease or renal failure. Methods and Results. Of the patients (n=215) studied, 37 had acute skeletal muscle injury, 10 had chronic muscle disease, nine were marathon runners, and 159 were chronic dialysis patients. Patients were evaluated clinically, by ECG, and by two-dimensional echocardiography. Total creatine kinase (normal, <170 IU/L) was determined spectrophotometrically, and cTnI (normal, <3.1 ng/mL) and MBCK (normal, <6.7 ng/mL) were determined with specific monoclonal antibodies. Values above the upper reference limit were considered "elevated." Elevations of total creatine kinase were common, and elevations of MBCK occurred in 59%o of patients with acute muscle injury, 78% of patients with chronic muscle disease and marathon runners, and 3.8%o of patients with chronic renal failure. Some of the patients were critically ill; five patients were found to have had myocardial infarctions and one had a myocardial contusion. cTnI was elevated only in these patients. Conclusions. Elevations of cTnI are highly specific for myocardial injury. Use of cTnI should facilitate distinguishing whether elevations ofMBCK are due to myocardial or skeletal muscle injury. (Circulation 1993;88:101-106)