Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction

R. S. Stack, H. Phillips, D. S. Grierson, V. S. Behar, Y. Kong, R. H. Peter, J. L. Swain, J. C. Greenfield

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

The effect of reperfusion on regional left ventricular performance following acute myocardial infarction in man was determined. Intracoronary streptokinase was administered in 24 patients within 6 h of the onset of symptoms. 15 patients (62%) were successfully recanalized during the initial study. Mean percent radial shortening (%RS) in both the jeopardized and compensatory regions were determined using 23 radii from the centroid of diastolic and systolic angiographic silhouettes. Sequential measurements were obtained during repeat cardiac catheterization studies at 24 h in 19 patients and before discharge from the hospital (16 ± 11 d) in 15 patients. At the time of the predischarge study, each acutely reperfused patient showed improvement in %RS in the jeopardized region (P = 0.01) with 56% returning to the normal range. Despite the uniform improvement in the contractile function of the jeopardized region in each reperfused patient, the global ejection fraction showed no improvement or a decrease at the time of the chronic study in 44%. This was due to a decrease in the compensatory wall motion in the uninvolved segments between the acute and chronic study in each case. Neither the %RS nor the ejection fraction changed significantly at the time of the chronic study in the patients who could not be acutely recanalized. These data indicate (a) significant salvage of jeopardized myocardium associated with recovery of contractile function in patients reperfused during the first 6 h of chest pain following acute myocardial infarction; (b) no improvement in regional or global left ventricular performance in patients who could not be reperfused acutely; and (c) the ejection fraction is strongly influenced by changes in the compensatory wall motion of the uninvolved segments and does not accurately reflect changes in the contractile function of the jeopardized myocardium.

Original languageEnglish
Pages (from-to)84-95
Number of pages12
JournalJournal of Clinical Investigation
Volume72
Issue number1
StatePublished - Sep 23 1983
Externally publishedYes

Fingerprint

Streptokinase
Myocardium
Myocardial Infarction
Patient Discharge
Recovery of Function
Cardiac Catheterization
Chest Pain
Reperfusion
Reference Values

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Stack, R. S., Phillips, H., Grierson, D. S., Behar, V. S., Kong, Y., Peter, R. H., ... Greenfield, J. C. (1983). Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction. Journal of Clinical Investigation, 72(1), 84-95.

Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction. / Stack, R. S.; Phillips, H.; Grierson, D. S.; Behar, V. S.; Kong, Y.; Peter, R. H.; Swain, J. L.; Greenfield, J. C.

In: Journal of Clinical Investigation, Vol. 72, No. 1, 23.09.1983, p. 84-95.

Research output: Contribution to journalArticle

Stack, RS, Phillips, H, Grierson, DS, Behar, VS, Kong, Y, Peter, RH, Swain, JL & Greenfield, JC 1983, 'Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction', Journal of Clinical Investigation, vol. 72, no. 1, pp. 84-95.
Stack, R. S. ; Phillips, H. ; Grierson, D. S. ; Behar, V. S. ; Kong, Y. ; Peter, R. H. ; Swain, J. L. ; Greenfield, J. C. / Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction. In: Journal of Clinical Investigation. 1983 ; Vol. 72, No. 1. pp. 84-95.
@article{6531103a23be49e1a733c97ed596d22c,
title = "Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction",
abstract = "The effect of reperfusion on regional left ventricular performance following acute myocardial infarction in man was determined. Intracoronary streptokinase was administered in 24 patients within 6 h of the onset of symptoms. 15 patients (62{\%}) were successfully recanalized during the initial study. Mean percent radial shortening ({\%}RS) in both the jeopardized and compensatory regions were determined using 23 radii from the centroid of diastolic and systolic angiographic silhouettes. Sequential measurements were obtained during repeat cardiac catheterization studies at 24 h in 19 patients and before discharge from the hospital (16 ± 11 d) in 15 patients. At the time of the predischarge study, each acutely reperfused patient showed improvement in {\%}RS in the jeopardized region (P = 0.01) with 56{\%} returning to the normal range. Despite the uniform improvement in the contractile function of the jeopardized region in each reperfused patient, the global ejection fraction showed no improvement or a decrease at the time of the chronic study in 44{\%}. This was due to a decrease in the compensatory wall motion in the uninvolved segments between the acute and chronic study in each case. Neither the {\%}RS nor the ejection fraction changed significantly at the time of the chronic study in the patients who could not be acutely recanalized. These data indicate (a) significant salvage of jeopardized myocardium associated with recovery of contractile function in patients reperfused during the first 6 h of chest pain following acute myocardial infarction; (b) no improvement in regional or global left ventricular performance in patients who could not be reperfused acutely; and (c) the ejection fraction is strongly influenced by changes in the compensatory wall motion of the uninvolved segments and does not accurately reflect changes in the contractile function of the jeopardized myocardium.",
author = "Stack, {R. S.} and H. Phillips and Grierson, {D. S.} and Behar, {V. S.} and Y. Kong and Peter, {R. H.} and Swain, {J. L.} and Greenfield, {J. C.}",
year = "1983",
month = "9",
day = "23",
language = "English",
volume = "72",
pages = "84--95",
journal = "Journal of Clinical Investigation",
issn = "0021-9738",
publisher = "The American Society for Clinical Investigation",
number = "1",

}

TY - JOUR

T1 - Functional improvement of jeopardized myocardium following intracoronary streptokinase infusion in acute myocardial infarction

AU - Stack, R. S.

AU - Phillips, H.

AU - Grierson, D. S.

AU - Behar, V. S.

AU - Kong, Y.

AU - Peter, R. H.

AU - Swain, J. L.

AU - Greenfield, J. C.

PY - 1983/9/23

Y1 - 1983/9/23

N2 - The effect of reperfusion on regional left ventricular performance following acute myocardial infarction in man was determined. Intracoronary streptokinase was administered in 24 patients within 6 h of the onset of symptoms. 15 patients (62%) were successfully recanalized during the initial study. Mean percent radial shortening (%RS) in both the jeopardized and compensatory regions were determined using 23 radii from the centroid of diastolic and systolic angiographic silhouettes. Sequential measurements were obtained during repeat cardiac catheterization studies at 24 h in 19 patients and before discharge from the hospital (16 ± 11 d) in 15 patients. At the time of the predischarge study, each acutely reperfused patient showed improvement in %RS in the jeopardized region (P = 0.01) with 56% returning to the normal range. Despite the uniform improvement in the contractile function of the jeopardized region in each reperfused patient, the global ejection fraction showed no improvement or a decrease at the time of the chronic study in 44%. This was due to a decrease in the compensatory wall motion in the uninvolved segments between the acute and chronic study in each case. Neither the %RS nor the ejection fraction changed significantly at the time of the chronic study in the patients who could not be acutely recanalized. These data indicate (a) significant salvage of jeopardized myocardium associated with recovery of contractile function in patients reperfused during the first 6 h of chest pain following acute myocardial infarction; (b) no improvement in regional or global left ventricular performance in patients who could not be reperfused acutely; and (c) the ejection fraction is strongly influenced by changes in the compensatory wall motion of the uninvolved segments and does not accurately reflect changes in the contractile function of the jeopardized myocardium.

AB - The effect of reperfusion on regional left ventricular performance following acute myocardial infarction in man was determined. Intracoronary streptokinase was administered in 24 patients within 6 h of the onset of symptoms. 15 patients (62%) were successfully recanalized during the initial study. Mean percent radial shortening (%RS) in both the jeopardized and compensatory regions were determined using 23 radii from the centroid of diastolic and systolic angiographic silhouettes. Sequential measurements were obtained during repeat cardiac catheterization studies at 24 h in 19 patients and before discharge from the hospital (16 ± 11 d) in 15 patients. At the time of the predischarge study, each acutely reperfused patient showed improvement in %RS in the jeopardized region (P = 0.01) with 56% returning to the normal range. Despite the uniform improvement in the contractile function of the jeopardized region in each reperfused patient, the global ejection fraction showed no improvement or a decrease at the time of the chronic study in 44%. This was due to a decrease in the compensatory wall motion in the uninvolved segments between the acute and chronic study in each case. Neither the %RS nor the ejection fraction changed significantly at the time of the chronic study in the patients who could not be acutely recanalized. These data indicate (a) significant salvage of jeopardized myocardium associated with recovery of contractile function in patients reperfused during the first 6 h of chest pain following acute myocardial infarction; (b) no improvement in regional or global left ventricular performance in patients who could not be reperfused acutely; and (c) the ejection fraction is strongly influenced by changes in the compensatory wall motion of the uninvolved segments and does not accurately reflect changes in the contractile function of the jeopardized myocardium.

UR - http://www.scopus.com/inward/record.url?scp=0020524021&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0020524021&partnerID=8YFLogxK

M3 - Article

C2 - 6874955

AN - SCOPUS:0020524021

VL - 72

SP - 84

EP - 95

JO - Journal of Clinical Investigation

JF - Journal of Clinical Investigation

SN - 0021-9738

IS - 1

ER -