Effect of acute myocardial infarction on serum zinc level

Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87
Original article :
Effect of acute myocardial infarction on serum zinc level
* DR. PRAVIN P. SHEKOKAR 1, DR. MRS. S. D. KAUNDINYA2
1Assistant
Professor, Department of Physiology, Government Medical College, Akola, Collector Office Road, Akola. Pin
444001 (Maharashtra), India
2Professor
& Head of Dept, Department of Physiology, Grant Government Medical College And Sir J.J. Hospital,
Mumbai-8, India
*Corrersponding author : Email: [email protected]
Abstract:
Introduction: Myocardial infarction is a common presentation of coronary artery disease. The diagnosis of acute
myocardial infarction (AMI) is of vital importance from the management and prognosis point of view.
Objective: The purpose of this study was to investigate serum zinc level in acute myocardial infarction patients and to
correlate it with biochemical parameter SGOT.
Methods: In the present study 30 patients suffering from acute myocardial infarction were taken as a study group with
inclusion & exclusion criteria & were compared with the healthy control group. The serum zinc levels of both the groups
were estimated on G.B.C.932 model atomic absorption spectrophotometer. The data were analyzed by student unpaired ttest.
Results: The serum zinc level in acute myocardial infarction patients was significantly low as compared to healthy
controls. In patients with AMI, there was good correlation between the serum zinc level and the biochemical marker of AMI
like SGOT.
Conclusion: A fall in plasma zinc is a reliable diagnostic test for acute myocardial infarction, and the extent of the fall has
prognostic implications. Oral zinc administration to the patients of AMI may be helpful in the prognosis.
Key words: Acute myocardial Infarction, Serum zinc
INTRODUCTION
Myocardial infarction results in death of
Myocardial infarction is one of the dangerous
myocardial cells. The acute inflammatory response
manifestations of coronary artery disease and is one
due to cell death, results in the liberation of
of the commonest causes of mortality. It has now
intracellular enzymes in the circulation several
become an important health problem despite
hours later. The intracellular enzymes routinely
advancement in diagnosis and management over
measured in the clinical laboratory for the purpose
the
Health
of diagnosing and monitoring myocardial infarction
organization estimated in 2004, that 12.2% of
include creatine kinase (CK), aspartate amino
worldwide deaths were from ischemic heart disease
transferase
(1)
. The disease is often premature and severe, with
dehydrogenase (LDH). These enzymes are present
serious complications. Because of its frequency of
in sufficiently high content in myocardial tissue so
occurrence and potentially dreaded complications,
that the death of a relatively small amount of tissue
the diagnosis of acute myocardial infarction (AMI)
results in a substantial increase in measured
is of vital importance from management and the
enzyme activity in serum (2).
last
few
decades.
The
World
(SGOT
or
AST),
and
lactate
prognosis point of view.
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Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87
Zinc is one of the essential trace elements in man.
a)
History of prolonged and severe
It is involved in nearly all aspects of cellular
characteristic chest pain lasting more
metabolism and is essential for cell division and
than half an hour with associated
DNA synthesis. Availability of zinc regulates the
symptoms,
rate of synthesis of nucleic acids and proteins
b)
suggesting that its availability may critically
influence
tissue
reparative
processes
(3,4,5)
Characteristic
electrocardiographic
abnormalities
of
acute
MI
on
.
standard 12 lead ECG like abnormal
Estimation of serum zinc levels can be diagnostic
'Q' or 'QS' wave, ST segment
of various diseases. Serum zinc levels have been
elevation, T wave inversion,
observed to fall after acute tissue injury irrespective
c)
Raised
cardiac
specific
serum
of its origin, including myocardial infarction, which
enzymes like CPK-MB, CPK (T),
produces some of the most striking falls. Levels of
SGOT etc.
zinc fall by 30 % within one or two days following
d)
Clinical examination of the patient,
acute myocardial infarction. At the same time the
Patients
extent of the fall also correlated with the
excluded from the study:
complications of acute myocardial infarction.
having
a)
following
conditions
were
Patients having a previous history of
Therefore it may serve as a yet another indicator in
AMI or IHD or Diabetes mellitus
assessing the prognosis following acute myocardial
b) Patients with non-Q wave infarct,
infarction
(6,7,8)
. The present study was undertaken
c)
ECG
showing
left
ventricular
to evaluate serum zinc levels in acute myocardial
hypertrophy, bundle branch block,
infarction patients and to correlate it with one of
d) Patients with other medical illness
the important biochemical parameters like SGOT
like diabetes mellitus, hypertension,
level
(2)
.
alcoholic liver
MATERIALS & METHODS
disease,
hepatitis,
cerebro-vascular episode.
In the present study, 60 subjects (both males and
e) Patients on supplemental zinc
females) were studied and they were divided in 2
Detailed history as per the proforma
groups,
Healthy
Acute
and clinical examination of every subject
Myocardial infarction (30) group. The study was
involved in the study was done including
conducted at Sir J. J. Group of Hospitals, Mumbai
electrocardiogram. Serum zinc level and SGOT
during the year 2002-03. Thirty normal healthy
were estimated in all the groups on the second
staff personnel working in the basic sciences
day of hospitalization to ICU. The individuals
departments with no history of any medical illness
were given an explanation about the relevance
were included in this group as a control. Thirty
of the study and the procedures. The
Acute Myocardial infarction patients satisfying the
participants gave informed written consent to
inclusion criteria, irrespective of age and sex,
participate in the experiment which was
admitted at Medical Intensive Care Unit, Dept. of
approved
Medicine, Sir J. J. Hospital, Mumbai were
committee of the institute.
randomly selected for this study. Diagnosis of AMI
Collection of blood sample
was made using general guidelines based on WHO
Taking usual aseptic precautions, 5 ml of fasting
criteria for MI
(9)
Control
(30)
which includes:
and
by
a
human
research
ethics
blood sample was collected from an antecubital
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Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87
vein into plastic test tubes taking care to prevent
screw caps. The serum thus collected from all the
the hemolysis and contamination. The sample was
groups was subjected for estimation of serum zinc
centrifuged at 3000 RPM for 15 minutes at
(10)
Hematology Laboratory, Dept. Of Physiology,
measured by the colorimetric method.
and SGOT (11) on the same day. SGOT were
GMC, Mumbai. The supernatant serum (about 3
ml) was taken and delivered into plastic tubes with
Preparation of sample for estimation of serum zinc level
The serum prepared by above method was processed in the following way.
1)
1 ml serum
+
In Corning’s beaker
2)
Sample
+
Add 5 ml of
boil the sample till
cons. Nitric acid
(This step is repeated 3 times)
Add 2 ml of Perchloric acid
Evaporation
boil the sample till
Evaporation
3) Sample
+ Add 25 ml of dil. Nitric acid
boil the sample to reduce
(2 M HNO3)
4) Sample
+
volume for 10-15 minutes
Add distilled water
Sample ready for analysis by
To make the volume 25 ml
AAS
In our study, the analysis was performed by G. B.
Absorbance Vs Concentration is plotted. Concent-
C. 932 model atomic absorption spectrophotometer
rations of zinc in specimen samples were derived
at B.A.R.C Institute of Science, Colaba, Mumbai
from comparison of sample absorption with the
and the instrument was used in accordance with the
standard zinc curve. The results were expressed in
manufacturers operating manual. The zinc level
micrograms per 100 ml (mcg/dl).
was determined by comparing the signal from
Statistical analysis: After the data was obtained
diluted serum with the signal from aqueous
and tabulated it was subjected to statistical analysis
standards. First the zinc standard solutions were
using
aspirated sequentially from most dilute to most
significance of values obtained was found by
concentrate. Then the diluted specimen serum
determining 'p' value. The 'p' value obtained was in
samples were aspirated into the atomic absorption
comparison with the control group. The results
flame and analyzed and their
obtained on analysis were presented as Mean ±
recorded.
absorbance’s
The resulting values were used to
establish the working curve.
student’s
unpaired’
t’
test
and
the
Standard Deviation for each of the parameters.
A graph of
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Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87
RESULTS
In the present study, total 60 subjects both male and female were studied. They were divided into the following
groups.
Table 1: Showing distribution of study group subjects and their serum zinc levels
Serum zinc levels (In mcg/dl)
Sr.
Group
No.
No.
1.
of
Male
Female
Range
Mean± S.D.
Std.
cases (n)
Group A-
Error
30
20
10
104 to 130
114.46 ± 7.632
1.39
30
19
11
55 - 120
81.1±16.09
2.93
Control
2.
Group B –
AMI
Group A: Serum zinc was estimated in 30
Group B: Serum zinc was estimated in 30 acute
apparently healthy volunteers consisting of 20
myocardial infarction patients consisting of 19
males and 10 females with an age range from 25
males and 11 females with an age range from 36
yrs to 48 yrs (mean age was 37.2 ± 12.4 yrs). It is
yrs to 71 yrs. (Mean age was 54.16 yrs.) The serum
evident from the above table that serum zinc level
zinc level in AMI patients was ranging from 55 to
in normal subjects was ranging from 104 to 130
120 mcg/dl with a mean value of 81.10 mcg/dl.
mcg/dl with a mean value of 114.46 mcg/dl.
Table 2: Showing mean and S.D. of serum zinc level in control and AMI group
Sr.
Serum
zinc
in
No.
control and AMI
No.
of
Serum zinc levels (mcg/dl)
cases
Range
Mean
S. D.
t
p
-8.99
0.000
group
1.
Zinc in control
30
104 - 130
114.46
7.63
2.
Zinc in AMI
30
55 - 120
81.1
16.09
*S
*S - Significant
The above table shows that serum zinc level in control and AMI group show statistically significant difference.
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Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87
Graph showing serum zinc level in control and AMI
130
120
110
Serum zinc level (mcg/dl)
100
90
80
70
60
50
40
30
20
10
0
Control
AMI
Shaded area indicates the mean value and line inside the shaded area shows range value
Table 3: Showing mean and S.D. of SGOT and serum zinc level in AMI group
Sr.
SGOT/
Zinc
No.
level
1.
SGOT in AMI
2.
Zinc in AMI
No. of cases
Serum zinc levels (mcg/dl)
Range
Mean
S. D.
30
18 - 189
64.33
35.24
30
55 - 120
81.10
16.09
t
p
-1.97
0.58
*N.
S.
* N. S. - Not significant
The above table shows that serum zinc level and SGOT level in the AMI group do not show a statistically
significant difference.
Table 4:
Showing the correlation between serum zinc level and SGOT level in AMI
Mean SGOT level in
Mean
serum
zinc
Correlation
AMI
level in AMI
coefficient
64.33
81.10
-0.585
Significance
P = 0.001 *S
*S - Significant
The above table shows that there is an inverse correlation ship of serum zinc and SGOT in AMI group.
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Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87
DISCUSSION
plasma zinc level as a nonspecific response to acute
The present study was carried out to evaluate the
stress. Flynn et al
role of serum zinc in Acute myocardial infarction.
adenohypophyseal - adrenocortical system which
I. Serum zinc in control group: In this study,
maintains the circulating zinc and mobilizes body
serum zinc was estimated in 30 healthy individuals.
zinc stores. It is possible that fall in zinc level after
The serum zinc level in the control group was
AMI may be steroid related. During stress, there is
ranging from 104-130 mcg/dl (mean value of
a release of a humoral factor produced by
114.46 mcg/dl). These values are comparable with
polymorphs i.e. Leukocyte Endogenous Mediator
studies done by various workers viz. Rosner et al
(LEM) which depresses plasma zinc levels and
(5)
increases zinc uptake by the liver
(8)
, Halstead et al
, Prasad et al
(10)
The average
(16)
supported the hypothesis of
(17)
. An increase
serum zinc in our study in normal individuals was a
in such a humoral agent after infarction might well
little higher than reported by these authors. The
explain the observed fall in serum zinc levels.
difference in the values of normal serum zinc may
Whatever the etiopathology, the fall in serum zinc
be due to different geographical and environmental
level in reliable and hence useful diagnostic index
factors, dietary intake and different methods of
in cases of AMI.
estimation used.
In our study, we also tried to correlate the
II. Serum zinc in Acute Myocardial Infarction:
extent of fall in serum zinc with that of SGOT level
The serum zinc level in the control group was
in AMI. The estimation of SGOT levels was
ranging from 104 to 130 mcg/dl (mean value of
carried out in AMI patients on the third day of
114.46 mcg/dl). Whereas the serum zinc in AMI
acute infarction. The SGOT level was ranging from
group was ranging from 55 to 120 mcg/dl (mean
18 to 189 IU/ml (mean value of 64.33 IU/ml). The
value of 81.1 mcg/dl). We observed a statistically
serum zinc level was ranging from 55 to 120
significant low serum zinc level estimated on the
mcg/dl) mean value of 81.10 mcg/dl). This study
rd
3 day of infarction in the AMI group as compared
has found an inverse correlationship between the
to normal healthy controls.
rise in SGOT level and fall in serum zinc level but
The same was observed by studies done
by Wendy et al
(12)
, Mishra et al
(2)
, Halstead et al
(13)
, Surana et al
(8)
, Lindeman et al
(14)
. These workers
it was not statistically significant. In contrast to our
study, various studies done by Wendy et al
Mishra et al
(13)
, Surana et al
(14)
(2)
,
have found a
did serial estimation of zinc from the first day of
statistically significant difference in the mean zinc
acute myocardial infarction and they found out the
level and the peak of SGOT level. They also
significantly lowest serum zinc level in AMI after
observed an inverse correlationship between the
48 hrs. of an acute attack and the level rises
low level of serum zinc and the peak value of
gradually as the patient recovers becoming normal
SGOT level which is in accordance with our study.
2 weeks later. In the present study, serum zinc
The difference in the observations of these studies
estimation was therefore, done on the third day of
may be due to time of estimation of serum zinc and
AMI which was found to be low.
SGOT level. In the previous studies, serial
Bailey et al
(15)
suggested the mechanism
estimation of serum zinc and SGOT level was
for the fall in serum zinc level in AMI patients to
carried out. Whereas, in the present study, the
be an adrenal-cortical response to the stress of
serum zinc and SGOT level were measured on the
AMI. Halstead et al
(8)
suggested the fall in the
third day of acute infarction.
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Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87
The data presented in this study indicate that a fall
levels and fall in serum zinc level but it was
in serum zinc is a useful diagnostic test for AMI. It
not statistically significant.
also
suggests
that
anti-oxidant
medication
ACKNOWLEDGEMENT
containing zinc may be beneficial in myocardial
The authors wish to express their acknowledgement
infarction and is highly recommended to improve
to the Professor and HOD of Medicine and of
patient outcome. The limitation of the present study
Biochemistry, GMC, and Mumbai. The authors
was that this could not find the correlation of the
also acknowledge their gratitude to the laboratory
extent of the fall with the complications of acute
technical staff of Dept. of physiology, Grant Govt.
myocardial infarction.
Medical College, Mumbai for technical assistance
CONCLUSION
and patients admitted at an Intensive Care Unit, Sir
1.
Normal serum zinc level was ranging from
J.J. group of hospitals, Mumbai for showing their
104 to 130 mcg/dl (mean value of 114.46
willingness to take part in the study as subjects.
mcg/dl). There was no change in the values
This study was undertaken for dissertation purpose
according to age and sex.
to appear for MD (Physiology) examination of
Serum zinc levels in acute myocardial
Mumbai University. The author himself had borne
infarction patients were ranging from 55 to
the cost of estimation of serum zinc level. Hence
120 mcg/dl (mean value of 81.10 mcg/dl)
there was no extra funding received for this study
which was significantly lower as compared
from any outside source.
2.
to healthy control values.
3.
This
study
has
found
an
inverse
correlationship between the rise in SGOT
REFERENCES
1. World Health Organization (2008). The Global Burden of Disease: 2004 Update
2. Wendy, I. L., Hamid, I. : Plasma zinc in acute myocardial infarction. Diagnostic and
Prognostic implications. Brit. Heart. J. 38 : 1339-1342, 1976
3. Bettiger, W. J., O'Dell, B. L. A. : Critical physiological role of the zinc in the structure and
function of biomembranes. Life Science. 28: 1425-38, 1981.
4. Prasad, A. S. : Clinical spectrum and diagnostic aspects of human zinc deficiency. In :
Prasad, A. S., Ed. Essential and toxic elements in human health and disease. New York :
Alan R. Liss., 301-314, 1988.
5. Rosner, F. and Gorien, P. C. : Erythrocyte and plasma zinc and magnesium levels in
health and disease. J. Lab. Clin. Med. 72: 213, 1968.
6. Low, W. L., Ikran, H. : Plasma zinc in acute myocardial infarction. Diagnostic and
prognostic implications. Br. Heart Hour. 38 : 1339, 1976.
7. Handjani, A. M., Smith, J. C., Hermann, J. B. and Halstead, J. A. : Zinc concentration in
acute myocardial infarction. Chest. 65 : 185, 1974.
8. Halstead, J. A., Smith, J. C. : Plasma zinc in health and disease. Lancet. 1 : 322, 1970.
9. Media et al. : Electrocardiogram in acute myocar infar. B. H. J. 42 : 286-295, 1999.
86
www.ijbamr.com P ISSN: 2250-284X E ISSN :2250-2858
Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87
10. Prasad, A. S., Smith, J. C., Butrimovitz, G. P. et al. : Direct measurement of zinc in plasma
by atomic absorption spectroscopy. Clin. Chem. 25(8): 1487-91, 1979.
11. Vasudevan : Testbook of Biochemistry, 2nd Edi. : 440, 2000.
12. Lindeman, R. D., Yunice, A. A., Baxter, J., Miller, L. R. Myocardial zinc metabolism in
experimental myocardial infarction. Jour. Lab. Clin. Med. 81 : 194, 1973.
13. Mishra, N. P., Bhargava, R. K., Yesiker, S. S., Mane, P. C. and Chauben, S. S. : Serum
zinc in acute myocardial infarction. I. H. J. 31(6) : 337, 1979.
14. Surana, N. K., Gupta, Rajeev, Gahlot, R. S. : Estimation of serum zinc in acute
myocardial infarction. J. A. P. I. 30(1) : 7-9, 1982.
15. Bailey, R. R., Abernethy, M. H., Beaven, D. W. : Adrenocortical response to the stress of
acute myocardial infarction. Lancet. 1 : 971, 1967.
16. Flynn, A., Pories, W. J., Strain, W. H., Hill, D. A., Eratianne, R. b. : Rapid serum zinc
depletion associated with corticosteroid therapy. Lancet. 2 : 1169, 1971.
17. Pekarek, R. S., Wannemacher, R. W. W. Jr., Beisel, W. R. : The effect of leucocytic
encogenous mediator (LEM) on the tissue distribution of zinc : Proc. Soc. Exp. Biol. Med.
140 : 685-688, 1972.
Date of submission: 25 Aug 2013
Date of Provisional acceptance: 15 September 2013
Date of Final acceptance: 20 October 2013
Date of Publication: 04 December 2013
Source of support: Nil; Conflict of Interest: Nil
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