Intravenous streptokinase for acute myocardial infarction. Effects on global and regional systolic function.

Martin, Gary V.; Sheehan, Florence H.; Stadius, Michael L.; Maynard, Charles; Davis, Kathryn; Ritchie, James L.; Kennedy, J. Ward

doi:10.1161/01.cir.78.2.258

Cited by 58 publications

(7 citation statements)

References 40 publications

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“…4,48 Table 5 lists currently available fibrinolytic agents. 314,[324][325][326]328,329 Fibrin-specific agents are preferred when available. Adjunctive antiplatelet and/or anticoagulant therapies are indicated, regardless of the choice of fibrinolytic agent.…”

Section: Timing Of Fibrinolytic Therapymentioning

confidence: 99%

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

O’Gara¹,

Kushner²,

Ascheim³

et al. 2013

Circulation

2,540

930

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Section: Timing Of Fibrinolytic Therapymentioning

confidence: 99%

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

O’Gara¹,

Kushner²,

Ascheim³

et al. 2013

Circulation

2,540

930

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“…The myocardium undergoes complex compensatory changes that help to restore the myocardial function [20]. As a result of these compensatory changes, global ejection may be normal in certain cases due to hyperkinesias of the normal segments [7, 8]; thereby global ejection fraction may not be true indicator of regional function. Information of REF may provide indirect evidence of improved myocardial function after revascularization and may be used to evaluate efficacy of new treatment strategies such as regenerative cell therapy [21, 22].…”

Section: Discussionmentioning

confidence: 99%

“…However due to compensatory hyperkinesias in the normal segments [7, 8], global ejection fraction may be normal in certain patients, thereby requiring an index which may be more indicative of regional myocardial function such as regional ejection fraction (REF). REF can be determined using echocardiography, nuclear magnetic resonance imaging, contrast ventriculography, radionuclide techniques and SPECT [9–14].…”

Section: Introductionmentioning

confidence: 99%

Computerized left ventricular regional ejection fraction analysis for detection of ischemic coronary artery disease with multidetector CT angiography

Zeb

Nasir

et al. 2012

Int J Cardiovasc Imaging

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Regional ejection fraction (REF) provides important functional information of the left ventricular regional myocardium. We aimed to test the diagnostic accuracy of computerized REF analysis for detecting the ischemia and significant stenosis with multidetector CT angiography (MDCT). This is a retrospective study including 155 patients who underwent MDCT scans for evaluation of coronary artery disease. Among them, 83 patients also underwent SPECT imaging and invasive coronary angiography (ICA). Two groups of patients were defined: Control group with 0 coronary artery calcium and normal global and regional ventricular function, and comparison group. REF measurement was performed on all patients using computerized software. Control group REF measurements will be used as reference standard (mean-2SD REF/mean global ejection fraction) to define abnormal REF. The sensitivity, specificity, positive and negative predictive value of REF in detecting perfusion defects (fixed and reversible) was 73, 80, 75 and 79 % respectively, in a patient based analysis of comparison group. The diagnostic accuracy of REF in predicting significant stenosis (>50 %) on ICA compared with SPECT was 72 versus 61 % and 85 versus 79 % in patient and vessel based analysis of comparison group, respectively. ROC curve analysis showed REF to be a better predictor of perfusion defects on SPECT compared with significant stenosis (>50 %) alone or stenosis combined with REF (P < 0.05). The computerized assessment of REF analysis is comparable to SPECT in predicting ischemia and a better predictor of significant stenosis than SPECT. This study also provides reference standard to define abnormal values.

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“…It is now widely accepted that early reperfusion thera py improves survival by limiting infarct size (myocardial salvage), and thus preserving LV function [2,18,19,[48][49][50][51][52][53], However, several studies have shown that the im provement in survival of patients with sustained patency of the IRA is greater than expected on the basis of improved global LV function alone [54. 55], It has been proposed that, in addition to time-dependent myocardial 28 Cardiology 1997;88(suppl 1 ):26-35 V isser salvage, beneficial effects of reperfusion therapy include attenuation of LV remodelling and promotion of elec trical stability that reflect time-independent effects of an open IRA ( fig.…”

Section: Reperfusion Therapybeyond Myocardial Salvagementioning

confidence: 99%

Infarct-Related Artery Patency and Long-Term Effects on Left Ventricular Remodelling

Visser

1997

Cardiology

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Within a narrow time frame after acute myocardial infarction (AMI), spontaneous or therapeutic reperfusion can lead to myocardial salvage, preservation of left ventricular (LV) function and improved survival. However, several studies have shown that the improvement in prognosis of patients with sustained patency of the infarct-related artery (IRA) is out of proportion to the observed improvement in ventricular function. Also, patients who undergo late thrombolysis (i.e. after the traditional 4- to 6-hour time window for myocardial salvage), show improvements in LV function and prognosis. These observations suggest that other mechanisms contribute to the beneficial effects of reperfusion in addition to the salvage of ischaemic myocardium. Experimental and clinical data support the concept the late reperfusion prevents LV dilatation and improves LV function by limiting infarct expansion and ventricular remodelling. These benefits are independent of any limitation on infarct size. Ventricular remodelling is a dynamic process, starting in the acute phase with infarct expansion, and progressing to LV dilatation and hypertrophy. The remodelling process has regional and global effects on wall thickness, and on chamber size, shape and function. Possible mechanisms by which late reperfusion limits infarct expansion independently of infarct size reduction include accelerated scar formation and healing, increased stiffness of the myocardium due to a blood-filled coronary vascular bed, and preservation of a subepicardial rim of viable cells. Evidence from trials of thrombolytic therapy given both early and late after AMI indicates that patency of the IRA is a critical predictor of progressive remodelling and LV dilatation in the long term. Long-term follow-up studies also show the importance of residual stenosis or reocclusion in this context. Thus, adequacy of reperfusion of the infarct bed may be more important than timing of reperfusion in attenuating LV dilatation. Since the pathogenesis of remodelling is influenced by many factors, the optimal therapeutic approach may involve a combination of treatment modalities targeted at several of the underlying processes. In fact, a variety of interventions show great promise in their ability to influence the remodelling process. In particular, there is increasing evidence that remodelling can be prevented through the use of late reperfusion therapy and therapy aimed at maintaining IRA patency in the long term. Based on current evidence, a rational strategy for the primary prevention of ventricular remodelling should involve intervention starting very early after infarction, spanning the entire healing process and continuing well beyond. Prospective clinical trials are required to evaluate late reperfusion therapy, as well as strategies for reducing residual stenosis, preventing reocclusion, and maintaining IRA patency in the long term.

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Intravenous streptokinase for acute myocardial infarction. Effects on global and regional systolic function.

Cited by 58 publications

References 40 publications

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction

Computerized left ventricular regional ejection fraction analysis for detection of ischemic coronary artery disease with multidetector CT angiography

Infarct-Related Artery Patency and Long-Term Effects on Left Ventricular Remodelling

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