Functional significance of predischarge exercise thallium-201 findings following intravenous streptokinase therapy during acute myocardial infarction
| Autor: | George A. Beller, Thomas W. Nygaard, Sanjiv Kaul, Denny D. Watson, Christine Tedesco, Dale A. Touchstone |
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| Rok vydání: | 1988 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Streptokinase Physical Exertion Myocardial Infarction Chest pain Internal medicine medicine Humans Myocardial infarction Infusions Intravenous Radionuclide Imaging Intravenous streptokinase Chemotherapy medicine.diagnostic_test business.industry Middle Aged medicine.disease Myocardial Contraction Patient Discharge Surgery Thallium Radioisotopes Angiography Coronary vessel Cardiology Exercise Test Female medicine.symptom Cardiology and Cardiovascular Medicine business Fibrinolytic agent medicine.drug |
| Zdroj: | American heart journal. 116(6 Pt 1) |
| ISSN: | 0002-8703 |
| Popis: | The purpose of this study was to determine which predischarge exercise thallium-201 imaging pattern(s) best correlate with myocardial salvage following intravenous streptokinase therapy (IVSK). Myocardial salvage was defined as improvement in regional left ventricular function determined by two-dimensional echocardiography between the time of admission and time of discharge in 21 prospectively studied patients receiving IVSK within 4 hours of chest pain. all patients had coronary angiography 2 hours following IVSK. Whereas 16 of the 21 patients (76%) had patent infarct-related vessels, only seven (33%) showed significant improvement in regional function at hospital discharge. Eleven patients demonstrated persistent defects (PD), and five each showed delayed and reverse redistribution. Patients with both delayed and reverse redistribution demonstrated significant improvement in regional left ventricular function score, while those with PD did not (+3.9 ± 3.3 versus −0.5 ± 2.9, p = 0.004). All other clinical, exercise, electrocardiographic, scintigraphic, and angiographic variables were similar between all patients, with the exception of the interval between chest pain and the institution of IVSK, which was longer in patients with reverse compared to delayed redistribution (3.5 ± 0.4 versus 2.2 ± 0.4 hours, p = 0.001). It is concluded that both delayed and reverse redistribution seen on predischarge exercise thallium-201 imaging are associated with myocardial salvage, defined as serial improvement in regional systolic function. Despite a high infarct vessel patency rate in patients with acute myocardial infarction receiving IVSK within 4 hours of onset of symptoms, only one third demonstrated improvement in regional function that was associated with either delayed or reverse redistribution seen on predischarge exercise thallium-201 imaging. |
| Databáze: | OpenAIRE |
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