title: Prolonged myocardial stunning after thrombolysis: can left ventricular function be assessed definitely at hospital discharge?
abstract: To assess whether myocardial dysfunction after acute reperfusion ('stunning') may show delayed recovery, 33 patients of the European Cooperative Study (rtPA vs placebo) had radionuclide angiocardiography on day 9 and after 3-6 months. Sixteen patients (13 inferior, three anterior infarcts) had a normal left ventricular ejection fraction (LVEF) which remained unchanged (55.4 vs 53.9%). In contrast, LVEF of 17 patients (10 inferior, seven anterior infarcts) with depressed values on day 9 improved during follow-up from 38.8 to 45.2% (P less than 0.01). Improvement was only observed in patients with early reperfusion defined a priori as peak creatine kinase value less than or equal to 15 h of pain onset (from 40.9 to 49.3%; P less than 0.05) in contrast to patients without reperfusion (from 34.0 to 35.2%; ns). Accordingly, LVEF increased in patients with open infarct-related arteries at hospital discharge (n = 8; P = 0.053) but not with persistent occlusion (n = 7; P = 0.11). Thus, a depressed LVEF observed 9 days after reperfusion may show delayed recovery due to prolonged stunning. Therefore, after thrombolysis, left ventricular function may not be evaluated definitively at hospital discharge; results of such studies should be interpreted with caution.
authors.affiliation: Division of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Pfisterer
authors.forename: M
authors.initials: M
authors.lastname: Zuber
authors.forename: R
authors.initials: R
authors.lastname: Wenzel
authors.forename: F
authors.initials: F
authors.lastname: Burkart
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D011877:Radionuclide Imaging; D011994:Recombinant Proteins / Q000008:administration & dosage; D012008:Recurrence; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D011994:Recombinant Proteins; D006493:Heparin; D010959:Tissue Plasminogen Activator; D001241:Aspirin