Characteristics of myoglobin, carbonic anhydrase III and the myoglobin/carbonic anhydrase III ratio in trauma, exercise, and myocardial infarction patients.

Carbonic anhydrase III (CA III) is an enzyme present in skeletal muscle which is released into circulation following injury. Myoglobin (Mb) is a heme protein located in skeletal, smooth, and cardiac muscle which is also released after injury. Because CA III is not present in myocardium, combining serum CA III and Mb measurements may improve the specificity of Mb as an early diagnostic marker for myocardial infarction (MI) provided that a fixed ratio of Mb and CA III is released from skeletal muscle following cell injury. We examined release of Mb and CA III for exercise subjects (n=12), trauma patients (n=18), and MI patients (n=10) following emergency department admission. A fixed ratio of Mb/CA III had medians of 3.505 (range: 1.05-6.76) and 2.890 (range: 0.97-3.97) for exercise and trauma subjects, respectively, in samples collected within 5 h of the event. The Mb/CA III ratio was significantly higher (P<0.001) in MI patients (median: 35.395; range: 8.65-170.45) during this same time. This study confirmed that Mb and CA III are released in a fixed ratio following exercise, showed no significant difference in the ratio for trauma patients, and demonstrated significant ratio elevation for MI patients. These data suggest the ratio to be a useful diagnostic indicator of MI.