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 ::  Abstract
 ::  Introduction
 ::  Material And Methods
 ::  Results
 ::  Discussion
 ::  References
 ::  Article Tables

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ARTICLE
Year : 1979  |  Volume : 25  |  Issue : 3  |  Page : 140-146

A comparative study of serum histaminase and serum glutamic oxaloacetic transaminase in acute myocardial infarction


Departments of Medicine and Biochemistry, L.L.R.M. Medical College, Meerut, India

Correspondence Address:
S K Gupta
Departments of Medicine and Biochemistry, L.L.R.M. Medical College, Meerut
India
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Source of Support: None, Conflict of Interest: None


PMID: 119046

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 :: Abstract 

Serum histaminase and SGOT were estimated in 35 cases of acute myocardial infarction and 34 cases of ischaemic heart disease (Other than acute myocardial infarction) and 30, age and sex match­ed, healthy subjects which served as controls, to evaluate the com­parison of time relation activity, diagnostic and prognostic value of histaminase and SGOT. The enzymes were estimated within 6 hours, then repeated -within 24 hours, 2nd day, 3rd day, 5th day, 10th day and 15th day, ascertained from the time o f pain in the chest.
Raised histaminase levels were found in 97.14%; cases, while SGOT levels were found elevated in only 91.4% cases of acute myo­cardial infarction of which 30 were electrocardiographically proved and 5 had equivocal electrocardiographic evidence of acute infarc­tion like LBBB, complete heart block, ventricular tachycardia and old myocardial infarction. Furthermore elevation of histaminase was 6.2 times whereas of SGOT only 5.2 times above the mean normal value.
Serum histaminase was found elevated in all the 6 cases who presented within 6 hours of infarction, while SGOT did not rise in any of these cases. Both histaminase and SGOT reached the peak levels on the 2nd day and persisted for whole of the first week. Higher levels of these enzymes were found associated with worse prognosis.
Above observations show that the serum histaminase rises earlier than SGOT and can prove the diagnosis of myocardial infarction even when SGOT and ECG fail to reveal the diagnosis. It is a more sensitive index and has higher peak rise of levels than SGOT. How­ever its pattern of rise, fall and prognostic values are similar to that of SGOT.



How to cite this article:
Gupta S K, Mehrotra T N, Singh V S, Elhence G P, Mittal H S, Mitra A. A comparative study of serum histaminase and serum glutamic oxaloacetic transaminase in acute myocardial infarction. J Postgrad Med 1979;25:140-6

How to cite this URL:
Gupta S K, Mehrotra T N, Singh V S, Elhence G P, Mittal H S, Mitra A. A comparative study of serum histaminase and serum glutamic oxaloacetic transaminase in acute myocardial infarction. J Postgrad Med [serial online] 1979 [cited 2019 Dec 11];25:140-6. Available from: http://www.jpgmonline.com/text.asp?1979/25/3/140/42130



 :: Introduction Top


The diagnostic and prognostic value of clinical judgement and electrocardio­graphy cannot be under-rated; however, in the search of a still better and earlier diagnostic tool, large number of enzymes have been evolved. SGOT is a well recognised enzyme estimated in cases of myocardial infarction. Serum histaminase has recently been added to the list. The present study evaluates the comparison of time relation activity, diag­nostic and prognostic value of hista­minase and SGOT.


 :: Material And Methods Top


This study has been carried out at the L.L.R.M. Medical College Hospital, Meerut on 30 healthy subjects and 34 cases of ischaemic heart diseases (other than acute myocardial infarction) which served as controls and 35 cases of acute myocardial infarction. The diagnosis of acute myocardial infarction and ischae­mic heart disease was made as per WHO criteria. [14],[15]

Electrocardiograms were taken on the 1st day, 2nd day, 4th day and 7th day of episode of infarction ascertained from the time of pain in the chest and then weekly for the next 6 weeks. Repeat electro­cardiograms were taken in special cir­cumstances as in fresh reinfarction or arrhythmias, LVF and shock. In every case, total and differential white cell count, ESR, blood sugar, blood urea and serum cholesterol were estimated.

Estimation of serum, histaminase and glutamic oxaloacetic transaminase (SGOT) was done by volumetric method of Kapeller-Adler [3] and Colorimetric method of Reitman and Frankel [9] respec­tively within 6 hours of infarction, repeat­ed within 24 hours and then on the 2nd day, 3rd day, 5th day, 1.0th day and 15th day ascertained from the time of pain in the chest. Whenever any complication occurred, repeat estimation was done.


 :: Results Top


The normal range of serum histaminase in the control group was 0.12-0.76 P.U/ml with a mean of 0.413 ± 0.176 P.U./ml. The minimum diagnostic level was taken 0.8 P.U./ml.

The normal range of SGOT in the con­trol group was 1.0-22 I.U./L with a mean of 11.7 ± 5.9 I.U./L. The minimum diag­nostic level was taken 30 I.U./L.

Serum histaminase levels in ischaemic heart disease (other than acute myo­cardial infarction) were well within normal limits, the mean being 0.417 ± ­ 0.23 P.U./ml. Similarly SGOT was also found within normal limit with a mean of 11.8 ± 4.72 I.U./L.

Of the 35 cases of acute :myocardial in­farction, 30 were ECG positive, the re­maining 5 cases were ECG negative but had convincing clinical evidence of acute myocardial infarction. 6 cases (5 from the ECG positive group and 1 from ECG negative group) presented within 6 hours of infarction and the remaining 29 pre­sented after 6 hours but earlier than 28 days.

Serum hustaminase was found elevat­ed in 34 (97.14%) out of 35 cases of acute myocardial infarction with a range of 1.0-4.60 P.U./ml. There was only one false negative case.

While SGOT was found elevated in 32 (91.4%) out of 35 cases with a range of 31-192 I.U./L, there were 3 false negative cases.

No false positive case was seen in either group.

Out of the 5 ECG negative cases, 2 had LBBB, 1 had old myocardial infarction, 1 had complete heart block and 1 had ven­tricular tachycardia. Serum histaminase and SGOT were diagnostically raised in all the 5 cases, the range of the para­meters being 1.4-4.3 P.U./ml and 32-167 I.U./ L respectively.

Serum histaminase started rising with­in 6 hours of the episode of myocardial infarction and all the 6 cases who pre­sented within 6 hours had diagnostic elevation of serum histaminase. On the other hand in none of these cases SGOT was found to be elevated above the diag­nostic levels (i.e. more than 30 I.U./L). This clearly indicates that serum hista­minase is an early diagnostic index of myocardial infarction in comparison to more often used enzyme SGOT. Both of these enzymes had maximum activity on the 2nd day (the peak values ranged from 1.7-3.8 P.U./ml with a mean of 2.44 P.U./ml and 23-192 I.U./L with a mean of 65.3 I.U./L. respectively). They start­ed declining from the 3rd day and were elevated in only 47.8% and 39.1% cases respectively on the 5th day. Serum his­taminase and SGOT were found elevated in none of the cases on the 10th day. Their levels on different days are shown in [Table 1].

Relation to complications

Of the 35 cases of acute myocardial in­farction, 18 (51.42%) had one or the other complication during the course of study. Of these 18 cases, 3 (16.66%) had cardiac failure, 5 (27.78%) had cardiac arrhythmias, 3 (16.66%) had cardiogenic shock and 7 (38,88%) had combination of complications.

The mean serum histaminase level in complicated cases was 3.07 ± 0.95 P.U./ml which was significantly higher than that in uncomplicated cases (2.36 ± 0.33 P.U/ml) (p < 0.05). The highest levels of histaminase were in cardiogenic shock (mean value 4.46 ± 0.13 P.U./ml) which were significantly higher in comparison to that of left ventricular failure (2.15 ± ­0.63 P.U./ml), congestive cardiac failure (2.4 P.U./ml) and arrhythmias (2.4 ± 0.54 P.U./ml).

The mean SGOT level in complicated cases was 70.1 ± 37.4 l:U. /L which was significantly higher than that in uncom­plicated cases (44.05 ± 9.7 I.U./L) (p < 0.05). Highest levels were recorded in cardiogenic shock (111.2 ± 66.5 I.U./L) which were significantly higher than those in left ventricular failure (55.0 I.U./L), congestive cardiac failure (44.7 I.U./L) and arrhythmias (55.2 ± 13.7 I.U./L). These are shown in [Table 2].

Relation to mortality

Out of 35 cases of acute myocardial in­farction 12 (34.28%) expired, due to one or the other complications and in these cases histaminase and SGOT levels were significantly higher than in those whc survived (p < 0.05). Cardiogenic shock was the commonest cause of death (7 out of 12, 79.35%) in comparison to other complications like cardiac failure and arrhythmias [Table 3].

There was a direct correlation between the height of raised enzyme levels and mortality. Nine out of 10 cases who had peak histaminase levels above 3.0 P.U.­ml expired whereas only 3 expired out of 24 cases whose peak histaminase levels were below 2.9 P.U./ml. Similarly 7 expired out of 7 who had peak SGOT levels above 90 I.U./L and only 5 expired out of 27 who had SCOT levels below 90 I.U./L [Table 4].


 :: Discussion Top


In the healthy subjects, the serum histaminase levels were 0.12-0.76 P.U./ml with a mean of 0.413 ± 0.176 P.U./ml SGOT levels in healthy subjects rangec from 1.0-22 I.U./L with a mean of 11.7 ± 5.9 I.U./L.

In cases of ischaemic heart disease (other than acute myocardial infarction) the levels of serum histaminase and SGOT were well within normal limits, mean being 0.417:± - - 0.23 P.U./ml and 11.8 :L 4.72 I.U./L respectively.

The mean and the range of serum his­taminase in healthy subjects and in cases of ischaemic heart disease (Other than acute myocardial infarction) in the pre­sent study are in conformity with those obtained by Lahiri et al. [4] but contrary to Sainani et al . [12] who reported raised his­taminase levels in 3 out of 5 cases of coronary insufficiency and all the 4 cases of old myocardial infarction.

The mean and the range of SGOT values in healthy subjects and cases of ischaemic heart disease (other than acute myocardial infarction) are in con­formity with Rosalki and Wilkinson [10] and Pagliaro and Notarbartolo. [7],[8]

Among the 35 cases of acute myo­cardial infarction serum histaminase levels were diagnostically raised in 34 cases (97.15%), thus only 1 false negative case was seen. The rise was 6.2 times above the mean normal values. These observations are in agreement with Lahiri et al [4] and Sainani et al. [12] who found diagnostic elevation of histaminase in 97% and 98% cases respectively whereas Chandwani [1] found diagnostic elevation in all the 25 cases (100 %).

SGOT levels were diagnostically raised (5.2 times of mean normal values) in only 32 (91.4%) cases, and there were 3 false negative cases. These observations are in conformity with Rudolph et al [11] and Mathur et al . [6]

In majority of cases serum histaminase started rising on the first day (within 6 hours) with a peak on the 2nd day. It started declining from the 3rd day and was elevated in only 47.8% cases on the 5th day and in none on the 10th day. These observations are in agreement with those of Lahiri et al. [4] but contrary to those of Chandwani [1] and Sainani et al. [12] who reported raised histaminase levels for whole of the 1st and 2nd week after in­farction.

In contrast, SGOT started rising on the first day but only after 6 hours. The peak was recorded on the 2nd day. It started declining from the 3rd day and was found elevated only in 39% cases on the 5th day and in none on the 10th clay. These findings are in con­formity with Mathur et al. [6] and West et al. [13]

Comparing the two enzymes, it has been found that histaminase is an early diagnostic index, is more sensitive and has high peak rise of levels than SGOT.

18 out of 35 cases (51.42%) of acute myocardial infarction developed one or the other complications and had signi­ficantly higher levels of serum hista­minase and SGOT as compared to those in uncomplicated cases (p < 0.05). The cases of cardiogenic shock revealed highest degree of enhancement of hista­minase and SGOT in comparison to cardiac failure and arrhythmias.

Furthermore, a direct correlation has been found between the height of eleva­tion of histaminase and SGOT and prog­nosis. Nine out of 10 cases expired who had peak histaminase levels above 3.0 P.U./ml whereas only 3 expired out of 24 who had peak histaminase levels be­low 2.9 P.U./ml. These observations are in conformity with those of Lahiri et al . [4] and Sainani et al. [12] Similarly 7 expired out of 7 who had peak SGOT levels above 90 I.U.//L and only 5 expired out of 27 who had peak SGOT levels below 90 LU./L. This is in conformity with Gour el al. [2] and Marrott et al. [5]



 
 :: References Top

1.Chandwani, M. L.: Personal communica­tion to Sainani, G. S. and D'Souza, E. H., 1970 (Ind. Heart J.. 27: 46-50, 1975.  Back to cited text no. 1    
2.Gour, K. N., Sikka, K K., Jain, S. C., Aggarwal, S. N. and Singh, J. K: SGOT and SGPT in health and disease. J. Ind.Med. Ass., 41: 346-356, 1963.  Back to cited text no. 2    
3.Kapeller-Adler, R.: A new volumetric method for determination of histaminase activity in biological fluids. Biochem. J.48: 99-105, 1951.  Back to cited text no. 3    
4.Lahiri, S. C., De, T. K. and Banerjee, J. C.: Enhancement of Plasma histaminase level in myocardial infarction. J. Ind. Med. Ass., 50: 95-58, 1968.  Back to cited text no. 4    
5.Marrott, P., Chopra, M. P., Portal, R. W. and Aber, C. P.: Discrepancies between electrocardiographic and enzyme evidence of myocardial infarction. Brit. Heart J. 35:1240-1244, 1973.  Back to cited text no. 5    
6.Mathur, K, S. and Gahlaut, D. S.: Glutamic oxaloacetic transminase activity in the diagnosis of myocardial infarction. J. Assoc. Phys. India, 7: 417-422, 1959.  Back to cited text no. 6    
7.Pagliaro, L. and Notarbartolo, A.: a Hy­droxybutyric dehydrogenase, in the detec­tion of myocardial infarction. Lancet, 2: 1261, 1961.  Back to cited text no. 7    
8.Pagliaro, L. and Notarbartolo, A: a Hy­droxybutyric dehydrogenase. in the diag­nosis of myocardial infarction. Lancet, 1:1043-1045, 1962.  Back to cited text no. 8    
9.Reitman, S. and Frankel, S.: A colori­metric method for determination of SGOT and SGPT. Am. J. Clin. Path., 28: 56-63, 1957.  Back to cited text no. 9    
10.Rosalki, S B. and Wilkinson, J. H.: Reduc­tion of a Ketobutyrate by human serum. Nature (London), 188: 1110-1111. 1960.  Back to cited text no. 10    
11.Rudolph, L. A., Dutton, R. E. and Schafer, J. H.: Glutamic oxaloacetic transaminase levels in experimental tissue damage. J. Clin. Invest., 34: 960, 1955.  Back to cited text no. 11    
12.Sainani. G. S. and D'Souza, E. H.: Value of serum histaminase in myocardial in­farction. Ind. Heart J., 27: 46-50, 1975.  Back to cited text no. 12    
13.West, M., Eshchar, J. and Zimmerman, H. J.: Serum enzymology in the diagnosis of myocardial infarction and related car­diovascular condition. Med. Clinic. Nor. Amer. 50: 171-191. 1966.  Back to cited text no. 13    
14.World Health Organisation Technical Report Series, 168: 25, 1959.  Back to cited text no. 14    
15.World . Health Organisation Technical Report Series, 231: 17, 1962  Back to cited text no. 15    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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