title: Long-term follow-up of global and regional left ventricular function by two-dimensional echocardiography after thrombolytic therapy in acute myocardial infarction.
abstract: In order to evaluate changes in left ventricular volumes and regional left ventricular function after thrombolytic therapy in acute myocardial infarction serial two-dimensional echocardiography was performed during a follow-up of 2 years in 206 consecutive patients treated with streptokinase and adjunctive angioplasty in a randomized group of patients. Unexpected progressive left ventricular enlargement was detected both with and without angioplasty. In anterior wall infarction, end-diastolic volume index increased from 55 +/- 14 to 91 +/- 28 ml/m2 (+65%, P < 0.01) and end-systolic volume index increased from 31 +/- 11 to 55 +/- 23 ml/m2 (+79%, P < 0.01), whereas ejection fraction decreased from 45 +/- 9 to 41 +/- 7% (-9%, P = NS). Averaged regional anterior wall motion improved during the first 4 weeks (11 +/- 10 to 16 +/- 12%), but subsequently deteriorated (16 +/- 12 to 10 +/- 6, P < 0.05). The number of segments with pathological wall motion increased. Similar volumetric and regional wall motion data were demonstrated in inferior wall infarction. We believe this reflects a chronic ventricular remodelling phenomenon. This process takes place predominantly during the first 3 months, but continues over the whole follow-up period. Forty percent of the patients suffered symptoms of heart failure on long-term follow-up. Attenuation of progressive ventricular enlargement remains a therapeutic challenge in the long-term care of these patients. Angiotensin-converting enzyme inhibitors are promising agents in this regard.
authors.affiliation: Johannes Gutenberg University, II Medical Clinic, Mainz, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Nixdorff
authors.forename: R
authors.initials: R
authors.lastname: Erbel
authors.forename: T
authors.initials: T
authors.lastname: Pop
authors.forename: H J
authors.initials: HJ
authors.lastname: Rupprecht
authors.forename: K J
authors.initials: KJ
authors.lastname: Henrichs
authors.forename: S
authors.initials: S
authors.lastname: Mörchen
authors.forename: J
authors.initials: J
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty; D001026:Coronary Artery Bypass; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D011446:Prospective Studies; D013300:Streptokinase / Q000627:therapeutic use; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D013300:Streptokinase