Prolonged myocardial stunning after thrombolysis: can left ventricular function be assessed definitely at hospital discharge?
PFISTERER, M. ; ZUBER, M. ; WENZEL, R. ; BURKART, F.
In: European Heart Journal, 1991, vol. 12, no. 2, p. 214-217
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- To assess whether myocardial dysfunction after acute reperfusion (‘stunning') may show delayed recovery, 33 patients of the European Cooperative Study (rtPA vs placebo) had radionuclide angiocardiography on day 9 and after 3-6 months. Sixteen patients (13 inferior, three anterior infarcts) had a normal left ventricular ejection fraction (LVEF) which remained unchanged (55.4 vs 53.9%). In contrast, LVEF of 17 patients (10 inferior, seven anterior infarcts) with depressed values on day 9 improved during follow-up from 38.8 to 45.2% (P<0.01). Improvement was only observed in patients with early reperfusion defined a priori as peak creatine kinase valuè ≤ 15 h of pain onset (from 40.9 to 49.3%; P<0.05) in contrast to patients without reperfusion (from 34.0 to 35.2%; ns). Accordingly, LVEF increased in patients with open infarct-related arteries at hospital discharge (n = 8; P = 0.053) but not with persistent occlusion (n = 7; P = 0.11). Thus, a depressed LVEF observed 9 days after reperfusion may show delayed recovery due to prolonged stunning. Therefore, after thrombolysis, left ventricular function may not be evaluated definitively at hospital discharge; results of such studies should be interpreted with caution