Koren O*, Rozner E, Abu-Daoud I and Turgeman Y
Background: Myocarditis and acute Myocardial Infarction pose a daily diagnostic dilemma. Magnetic resonance imaging and endomyocardial biopsy are the gold standard for definite diagnosis but are rarely performed routinely. Troponin and Creatine phosphokinase (CPK) are elevated in both diseases and could not be used for proper discrimination. We analyzed the dynamics of these serum markers during acute setting by analyzing the tangent slope of their level curve over time.
Methods: We conducted a retrospective cohort study in our medical center. Records of approximately 1,300 patients hospitalized from January 2011 to December 2016 were examined. A total of 193 patients were found to be eligible for the study and were divided into two groups: Myocarditis group (n=133, 69%) and non-ST elevation myocardial infarction group (n=60, 31%).
Results: The non-ST elevation myocardial infarction group was significantly older than the myocarditis group (mean age 68.7 vs 35.6 years, p<0.001). Median troponin and CPK levels were significantly higher in the myocarditis group (p<0.001). The tangent slope of troponin curve was significantly lower and CPK curve significantly higher in the myocarditis group (p=0.02 and p<0.001, respectively). Troponin-to-CPK ratio was lower within the first 48 hours from admission in the myocarditis group.
Conclusion: Our study demonstrates a unique discriminating pattern of serum markers curve in acute Myocarditis and acute Non-ST myocardial infarction. In acute myocarditis, troponin progress moderately while CPK progress steeply, both to higher peak, resulting in lower troponin to CPK ratio in the first 48 hours of admission.
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