Functional significance of predischarge exercise thallium-201 findings following intravenous streptokinase therapy during acute myocardial infarction

Dale A. Touchstone, George A. Beller, Thomas W. Nygaard, Denny D. Watson, Christine Tedesco, Sanjiv Kaul

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

The purpose of this study was to determine which predischarge exercise thallium-201 imaging pattern(s) best correlate with myocardial salvage following intravenous streptokinase therapy (IVSK). Myocardial salvage was defined as improvement in regional left ventricular function determined by two-dimensional echocardiography between the time of admission and time of discharge in 21 prospectively studied patients receiving IVSK within 4 hours of chest pain. all patients had coronary angiography 2 hours following IVSK. Whereas 16 of the 21 patients (76%) had patent infarct-related vessels, only seven (33%) showed significant improvement in regional function at hospital discharge. Eleven patients demonstrated persistent defects (PD), and five each showed delayed and reverse redistribution. Patients with both delayed and reverse redistribution demonstrated significant improvement in regional left ventricular function score, while those with PD did not (+3.9 ± 3.3 versus -0.5 ± 2.9, p = 0.004). All other clinical, exercise, electrocardiographic, scintigraphic, and angiographic variables were similar between all patients, with the exception of the interval between chest pain and the institution of IVSK, which was longer in patients with reverse compared to delayed redistribution (3.5 ± 0.4 versus 2.2 ± 0.4 hours, p = 0.001). It is concluded that both delayed and reverse redistribution seen on predischarge exercise thallium-201 imaging are associated with myocardial salvage, defined as serial improvement in regional systolic function. Despite a high infarct vessel patency rate in patients with acute myocardial infarction receiving IVSK within 4 hours of onset of symptoms, only one third demonstrated improvement in regional function that was associated with either delayed or reverse redistribution seen on predischarge exercise thallium-201 imaging.

Original languageEnglish (US)
Pages (from-to)1500-1507
Number of pages8
JournalAmerican Heart Journal
Volume116
Issue number6 PART 1
DOIs
StatePublished - 1988
Externally publishedYes

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Streptokinase
Thallium
Myocardial Infarction
Exercise
Therapeutics
Chest Pain
Left Ventricular Function
Coronary Angiography
Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Functional significance of predischarge exercise thallium-201 findings following intravenous streptokinase therapy during acute myocardial infarction. / Touchstone, Dale A.; Beller, George A.; Nygaard, Thomas W.; Watson, Denny D.; Tedesco, Christine; Kaul, Sanjiv.

In: American Heart Journal, Vol. 116, No. 6 PART 1, 1988, p. 1500-1507.

Research output: Contribution to journalArticle

Touchstone, Dale A. ; Beller, George A. ; Nygaard, Thomas W. ; Watson, Denny D. ; Tedesco, Christine ; Kaul, Sanjiv. / Functional significance of predischarge exercise thallium-201 findings following intravenous streptokinase therapy during acute myocardial infarction. In: American Heart Journal. 1988 ; Vol. 116, No. 6 PART 1. pp. 1500-1507.
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