[Evaluation of the size of thrombolysed myocardial infarction by serum myosin determination].
The prognosis of myocardial infarction is very dependent on the size of the infarct. The measurement of the infarct size after thrombolysis remains difficult despite the large number of methods available, all of which have drawbacks. This parameter is however essential to assess prognosis and the efficacy of thrombolytic therapy. Serum beta heavy chain myosin determination is a recently introduced method of evaluating infarct size; there are relatively few published studies, especially concerning post-thrombolytic patients. A prospective study was undertaken in 40 patients (37 men and 3 women: average age 55.6 years) with a primary myocardial infarction treated by thrombolysis. Myosin levels (peak and area under curve of 5 samples in 10 days) were compared with other methods of assessing infarct size: electrocardiogram (number of leads with Q waves, ST segment analysis), cardiac enzymes (peak and release integrals of CK abd LDH), contrast ventriculography (segmental asynergy score, ejection fraction), coronary angiography and resting MIBI myocardial scintigraphy. The peak and integral of myosin release correlated well with the other methods (p < 0.01): a correlation was particularly apparent between the integral of myosin release and MIBI scintigraphy scores (r = 0.77, p < 0.001). Complex myosin release kinetics were observed significantly more often in patients with large infarcts (p < 0.01) or in those with occlusion of the artery responsible for infarction at coronary angiography on the 6th day (p = 0.001). In conclusion, with 5 blood samples over a 10 day period, it is possible to estimate the infarct size after thrombolysis in everyday cardiological practice: this method could help identify high risk subjects (complex kinetics of myosin release and high peak myosin levels) and also could be used to assess efficacy of thrombolytic therapy in large scale trials.
Stordeur
J M
JM
Service de cardiologie, hôpital Gaston-Doumergue, Nîmes.
Messner
P
P
Bonardet
A
A
Kotzki
P O
PO
Larue
C
C
Bertinchant
J P
JP
Nigond
J
J
Grolleau
R
R
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D009218:Myosins / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D015912:Thrombolytic Therapy
D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase; D009218:Myosins
Evaluation de la taille de l'infarctus du myocarde thrombolysé par le dosage de la myosine sérique.