Biological variation of cardiac markers: analytical and clinical considerations.

The analytical, within-subject and between-subject components of variation were estimated for serum total creatine kinase (TCK) activity, CK-MB (creatine kinase-MB) activity, CK-MB mass, ratios of CK-MB activity and CK-MB mass to TCK activity and myoglobin concentration in a cohort of 16 apparently healthy subjects over 5 days. Analytical goals based on biological variation showed that, for all quantities except CK-MB mass, methodological improvement is warranted. All cardiac markers showed marked individuality which casts doubt on the utility of conventional population-based reference values as interpretative criteria. The critical differences required for significance of changes in serial results differ markedly from marker to marker and the data allow generation of objective criteria for monitoring individuals.