Author + information
- Received January 30, 1985
- Revision received March 27, 1985
- Accepted August 8, 1985
- Published online August 1, 1985.
- Eric J. Topol, MD*,a,b,
- James L. Weiss, MD, FACC*,
- Jeffrey A. Brinker, MD, FACC*,
- Kenneth P. Brin, MD, FACC*,
- Sidney O. Gottlieb, MD†,
- Lewis C. Becker, MD, FACC*,
- Bernadine H. Bulkley, MD, FACC*,
- Nisha Chandra, MD†,
- John T. Flaherty, MD, FACC*,
- Gary Gerstenblith, MD, FACC*,
- Sheldon H. Gottlieb, MD†,
- Alan D. Guerci, MD*,
- Pamela Ouyang, MD†,
- Michaelene P. Llewellyn, RN*,
- Myron L. Weisfeldt, MD, FACC* and
- Edward P. Shapiro, MD, FACC†
- ↵aAddress for reprints: Eric J. Topol, MD, Cardiology Division, The Johns Hopkins Hospital, Carnegie 591, 600 North Wolfe Street, Baltimore, Maryland 21205.
To evaluate functional recovery in 20 consecutive patients with acute myocardial infarction who received recombinant tissue-type plasminogen activator, serial twodimensional echocardiograms were performed before and immediately after tissue plasminogen activator administration and at 1 and 10 days postinfarction. Tissue plasminogen activator was administered intravenously (17 patients) or by intracoronary infusion (3 patients) after angiographic confirmation of total occlusion. Reperfusion, documented by angiography, occurred in 13 of the 20 patients. The mean time from onset of chest pain to thrombolysis was 5.1 ± 1.1 hours. Echocardiograms were evaluated for regional function with a visual semiquantitative scoring system by two independent observers who had no knowledge of patient identity, temporal sequence, therapy or effect of therapy.
There was no immediate or 24 hour improvement in wall motion. At day 10 compared with pretreatment, 28 of 33 reperfused infarct zone segments versus 6 of 20 nonreperfused infarct segments demonstrated improved wall motion (p = 0.01). This improvement did not relate to time from onset of chest pain to successful thrombolysis. Of reperfused infarct zone segments in the distribution of coronary artery balloon dilation, 19 of 23 segments exhibited improvement versus 7 of 17 (reperfused, no angioplasty) and 6 of 20 (nonreperfused, no angioplasty) segments (p = 0.001). Infarct zone segments reperfused at the time of ongoing chest pain demonstrated functional recovery compared with segments reperfused in the absence of chest pain (18 of 23 versus 10 of 20, respectively; p = 0.05).
Thus, in this uncontrolled series, there was echocardiographically detectable improvement in function of reperfused infarct segments 10 days after coronary thrombolysis with recombinant tissue plasminogen activator. The functional recovery occurred predominantly in patients who also had coronary artery balloon dilation or ongoing chest pain, or both, at the time of coronary thrombolysis.
↵b Dr. Topol was supported in part by a research fellowship from the American Heart Association, Maryland Affiliate, Baltimore, Maryland.
This study was supported by Ischemic Heart Disease Specialized Center of Research Grant 2P50-HL-17655 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland and Genentech, Inc., South San Francisco, California.
The study was presented in part at the 57th Scientific Sessions of the American Heart Association, Miami Beach, Florida, November 1984.
- Received January 30, 1985.
- Revision received March 27, 1985.
- Accepted August 8, 1985.
- American College of Cardiology Foundation