[Value of serum myoglobin in acute myocardial infarction. Kinetic study]. / Intérêt de la myoglobine sérique dans l'infarctus du myocarde aigu. Etude cinétique.

The rise in serum myoglobin (MGB), total CPK (CKT) and its MB isoenzyme (CK - MB) was studied and compared over the first three days of acute myocardial infarction (AMI) and correlations were sought between the peak values of these three parameters and haemodynamic and biological indices of left ventricular function. Blood was taken from MGB (radio immunological technique), CKT and CK - MB (spectrophotometry) estimation every 2 hours for 24 hours and then every 6 hours up to the 72nd hour in 36 patients with AMI less than 12 hours old. On admission, this protocol was completed by a haemodynamic study (right heart pressures, systemic blood pressure, cardiac output measurement by thermodilution), arterial gases and ECG recordings. The average delays before the pathological rise, the maximal peak value and the return to normal were significantly shorter (p less than 0.001) for MGB (2, 6 and 25 hours) than for CK - MB (5,16 and 34 hours) or CKT (5,21 and 57 hours). The sensitivity of the diagnosis of myocardial infarction was not significantly higher with MGB than CKT or CK - MB either in the whole group (sensitivity of 91.6 p. 100 for MGB and 86.1 p. 100 for CKT and CK - MB) or in a subgroup of ten patients without transmural infarction (70 p. 100 for MGB compared with 60 p. 100 for CKT and CK - MB). A significant correlation was found between the peak values of MGB (p less than 0.02) and CK- MB (p less than 0.02) and the indices of left ventricular function (PCP, PAO2 and LVSWI). This was not observed with CKT. In conclusion, apart form technical problems which remain unresolved time-consuming investigation), serum MGB gives a much earlier and as sensitive a biochemical diagnosis of AMI as CKT and CK - MB. MGB and CK - MB are much better prognostic indicators than CKT as judged by the indices of left ventricular function. Finally, MGB estimation should be of particular value in the diagnosis of secondary extension of infarction.

[Study of the valuations of serum muscular enzymes and myoglobin after maximal exercise test and during the next 24 hours (author's transl)]. / Etude des variations des taux seriques des enzymes musculaires et de la myoglobine après épreuve d' effort maximale et au cours des 24 heures suivantes.

Twenty-eight male subjects underwent a maximal exercise test on an ergometric bicycle, 13 untrained and 15 trained subjects. At rest and after this maximal exercise, indicated by the increase of the serum lactate and pyruvate acids, venous blood samples were taken to study the release of muscular enzymes (SGOT, SGPT, LDH, alpha HBDH, CPK, CPK MB) and myoglobin in the next 24 h (3 min, 30 min, 8 h and 24 h after the end of this test). The statistic analysis of the results shows significant increases in comparison with the values at rest, according to the enzymes and the groups of subjects, especially for CPK, SGOT, SGPT for which the results are homogeneous with a peak at the 3rd min and the 8th h in the three groups and for HBD and LDH in the groups of trained subjects. However these values remain most often within the normal limits. These results are compared with those of previous works on the same subjects.

[Traumatic myocardial infarct]. / L'infarctus du myocarde traumatique.

Two cases of traumatic, closed chest, myocardial infarction in two young patients, aged 18 and 19 years respectively, are reported. They illustrate the two possible physiopathological mechanisms of this affection: in the first case, myocardial contusion after thoraco-abdominal trauma by crushing, probably complicated by a subendocardial tear of the inferior wall of the left ventricle, with a spontaneous favourable outcome; in the second case, a transmural myocardial infarction was observed secondary to a coronary lesion (? tearing of the adventitia of the left anterior descending artery) complicated by the early development of a large antero-apical aneurysm. Haemodynamic and arrhythmic complications necessitated infarctectomy and aorto coronary bypass surgery on the 35th day. The pathological lesions and their outcome are examined with respect to these two cases. The diagnostic, therapeutic and medieolegal problems associated with this condition are also discussed.