ABSTRACT
A prospective, randomized trial was designed to assess the efficacy of intracoronary thrombolytic therapy with streptokinase (STK) in acute myocardial infarction. Sixty-four patients with acute myocardial infarction were randomized within 6 hours of onset of symptoms to 1 of 3 groups. Sixteen patients were treated by conventional means (control group). Nineteen patients underwent coronary arteriography and received corticosteroids and intracoronary and intravenous nitroglycerin (NTG group). Twenty-nine patients received management identical to that of the NTG group, with the addition of intracoronary STK therapy (STK group). Recanalization was demonstrated in 21 of 29 patients (72%) in the STK group. Global and regional ejection fraction (EF) was determined by radionuclide ventriculography before any intervention and 7 to 10 days later. No significant improvement in global EF was achieved in the control and NTG groups. In STK patients as a group, global EF did not increase significantly; however, in patients recanalized with STK, EF improved from 42 +/- 17% to 49 +/- 16% (p = 0.023). All groups showed wide variability of response. Improvement in global EF of more than 5% was noted in 44% of patients recanalized with STK. When subgrouped on the basis of initial global EF of 45% or less or more than 45%, only patients recanalized with STK with an initial EF of 45% or less had an improved global EF (from 30 +/- 10% to 42 +/- 10%, p = 0.015).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Coronary Disease/drug therapy , Infusions, Intra-Arterial , Myocardial Infarction/drug therapy , Streptokinase/therapeutic use , Aged , Clinical Trials as Topic , Female , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/physiopathology , Nitroglycerin/therapeutic use , Prospective Studies , Radiography , Radionuclide Imaging , Random Allocation , Stroke VolumeSubject(s)
Aortic Dissection/etiology , Cardiac Catheterization/adverse effects , Coronary Disease/etiology , Coronary Vasospasm/etiology , Aortic Dissection/diagnostic imaging , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Vasospasm/diagnostic imaging , Humans , Male , Middle AgedSubject(s)
Blood Volume , Coronary Circulation , Echocardiography/methods , Adult , Aged , Angiography , Female , Heart Ventricles , Humans , Male , Middle Aged , Regression AnalysisABSTRACT
An accurate and simplified method to calculate left ventricular (LV) ejection fraction (EF0 derived from the ellipsoidal formula for LV volume calculation is described. The LV Minor axis (D) is obtained from the average of three equidistant LV diameters at end-diastole (Ded) and end-systole (Des), and the shortening fraction of D2 (% delta D2) calculated as (D2ed - D2es)/D2ed. EF is calculated as EF = [delta D2 + ([1 - delta D2] X delta L)] X 100, where delta L = the shortening fraction of the long axis. The coefficient of correlation between the EF by this method and the EF derived from measurements of LV volumes with the area-length method was 0.98, SEE = 3.57% (n = 50). No significant over- or underestimation was observed according to the regression equation Y = 0.922X + 0.82. Thus, this simplified method allows accurate LVEF calculation without the need for planimetry of LV area.
