Author + information
- Received August 21, 1989
- Revision received December 22, 1989
- Accepted December 29, 1989
- Published online June 1, 1990.
- David S. Kayden, MD,
- Frans J.Th. Wackers, MD, FACC and
- Barry L. Zaret, MD, FACC∗
- ↵∗Address for reprints: Barry L. Zaret, MD, Yale University School of Medicine, Section of Cardiology, 333 Cedar Street-3 FMP, New Haven, Connecticut 06510.
To investigate prospectively the occurrence and significance of postinfarction transient left ventricular dysfunction, 33 ambulatory patients who underwent thrombolytic therapy after myocardial infarction were monitored continuously for 187 ± 56 min during normal activity with a radionuclide left ventricular function detector at the time of hospital discharge. Twelve patients demonstrated 19 episodes off transient left ventricular dysfunction (>0.05 decrease in ejection fraction, lasting ≥ 1 min), with no change in heart rate. Only two episodes in one patient were associated with chest pain and electrocardiographic changes. The baseline ejection fraction was 0.52 ± 0.12 in patients with transient left ventricular dysfunction and 0.51 ± 0.13 in patients without dysfunction (p = NS). At follow-up study (19.2 ± 5.4 months), cardiac events (unstable angina, myocardial infarction or death) occurred in 8 of 12 patients with but in only 3 of 21 patients without transient left ventricular dysfunction (p < 0.01). During submaximal supine bicycle exercise, only two patients demonstrated a decrease in ejection fraction >0.05 at peak exercise; neither had a subsequent cardiac event.
These data suggest that transient episodes of silent left ventricular dysfunction at hospital discharge in patients treated with thrombolysis after myocardial infarction are common and associated with a poor outcome. Continuous left ventricular function monitoring during normal activity may provide prognostic information not available from submaximal exercise test results.
☆ This study was supported in part by the Thrombolysis in Myocardial Infarction (TIMI) Trial, Contract N01-HV-38017 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.
- Received August 21, 1989.
- Revision received December 22, 1989.
- Accepted December 29, 1989.