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To the Editor.—
I should like to respond to the comments of Drs. Rock and Solomon regarding the diagnostic test for myocardial infarction utilizing myoglobinuria (229:1166, 1974).I do agree that more data are needed regarding reproducibility of quantitation of myoglobin in the urine. The method of radial immunodiffusion assay may well be too insensitive to the small changes in the excretion of myoglobin. The data reported were gathered from patients with definite unequivocal infarcts— more subtle areas of myocardial necrosis may lead to levels of myoglobin in the urine in microgram amounts. We are presently investigating more sensitive immunologic techniques to demonstrate these changes and to be able to reproduce the results.However, I do take issue with the conclusion that the myocardial isoenzyme of creatine phosphokinase may be the most productive measurement for infarction. Although skeletal muscle, as well as cardiac muscle, contains substantial amounts of myoglobin, a
Bernstein SH. Myoglobinuria and Myocardial Infarction. JAMA. 1975;231(2):138. doi:10.1001/jama.1975.03240140012012