Changes in left ventricular regional asynchrony after intracoronary thrombolysis in patients with impending myocardial infarction.

D Gibson, H Mehmel, F Schwarz, K Li, W Kübler

Ventriculograms obtained before and a mean (SD) of 4.3 (2.5) weeks after intracoronary thrombolysis in 23 patients who were treated within 3.5 (3.1) hours of the onset of pain were examined for changes in asynchronous left ventricular wall motion. Lysis was achieved in 19 patients, and in 16 the affected artery was still patent at restudy. Angiograms were digitised frame by frame. Left ventricular volumes, ejection fraction, and peak ejection rate were all unchanged after thrombolysis, whereas peak filling rate fell, whether or not patency was achieved or maintained. Regional wall motion was examined by means of isometric and contour plots. The area supplied by the affected coronary artery showed simple hypokinesis or akinesis in 10 cases, which was unchanged at the second study in nine and improved in one. The commonest manifestation of asynchrony was delayed inward motion during isovolumic relaxation. This was present in 12 cases with or without associated hypokinesis; after thrombolysis wall motion improved significantly in eight and returned to normal in six, significantly more frequently than it did in patients with simple hypokinesis. Dyskinesis (three patients) and hyperkinesis (five patients) resolved in all. Outward wall motion during isovolumic relaxation reverted to normal in four out of five cases, and outward motion during isovolumic contraction reverted to normal in five out of seven. The frequency of improvement was also increased when the circulation to the affected segment was not compromised by an important residual stenosis. Flow in the affected artery was re-established or maintained significantly less frequently when simple hypokinesis or akinesis was present at the first study. These observations provide further evidence that asynchronous wall motion early after acute myocardial infarction represents residual contractile activity, and suggest that knowledge of its presence and distribution may be useful in assessing patients on whom thrombolysis is performed.

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