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Clinical Chemistry 36: 1317-1322, 1990;
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Clinical Chemistry, Vol 36, 1317-1322, Copyright © 1990 by American Association for Clinical Chemistry

Time-related changes in the diagnostic utility of total lactate dehydrogenase, lactate dehydrogenase isoenzyme-1, and two lactate dehydrogenase isoenzyme-1 ratios in serum after myocardial infarction

LV Galbraith, FY Leung, G Jablonsky and AR Henderson
Department of Clinical Biochemistry, University Hospital, University of Western Ontario, London, Canada.

Using receiver-operating characteristic (ROC) curve and likelihood ratio analysis, we examined the diagnostic utility of total lactate dehydrogenase (LD; EC 1.1.1.27) activity (I). LD isoenzyme-1 activity (II), and the LD-1 percentage of total LD activity (III), LD-1 LD-2 (IV), and LD-1/LD-4 (V) in 347 persons admitted to the Cardiac Care Unit (of whom 173 were subsequently proven to have had myocardial infarction). Blood was sampled from these subjects at about 6-h intervals for up to 96 h from the onset of chest pain. Defining an "effective" test as one having an area under the ROC curve of greater than or equal to 0.9, we determined the ranked utility (greatest to least) of these tests as V = IV greater than III greater than II greater than I. Tests III, IV, and V had by this criterion, diagnostic effectiveness equivalent to measurements of creatine kinase-2 in serum but in samples obtained at later time intervals. The decision thresholds for both high (constant) test sensitivity and specificity varied with time, to differing extents, over the entire 96-h period, a finding with important diagnostic implications. We document positive and negative likelihood ratio values for each of these tests throughout the entire period of study.


The following articles in journals at HighWire Press have cited this article:


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 ANGIOLOGYHome page
P. C. Painter, S. Van Meter, R. L. Dabbs, and G. E. Clement
Analytical Evaluation and Comparison of Dupont aca(R) Lactate Dehydrogenase-1 (LD1) Isoenzyme Assay Diagnostic Efficiency for Acute Myocardial Infarction Detection with Other LD1 Methods and aca@ CK-MB: A Two-Site Study
Angiology, July 1, 1994; 45(7): 585 - 595.
[Abstract] [PDF]


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