LONG-TERM FOLLOW-UP OF GLOBAL AND REGIONAL LEFT-VENTRICULAR FUNCTION BY 2-DIMENSIONAL ECHOCARDIOGRAPHY AFTER THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL-INFARCTION

In order to evaluate changes in left ventricular volumes and regional left ventricular function after thrombolytic therapy in acute myocardi al infarction serial two-dimensional echocardiography was performed du ring a follow-up of 2 years in 206 consecutive patients treated with s treptokinase and adjunctive angioplasty in a randomized group of patie nts. Unexpected progressive left ventricular enlargement was detected both with and without angioplasty. In anterior wall infarction, end-di astolic volume index increased from 55 +/- 14 to 91 +/- 28 ml/m2 (+65% , P < 0.01) and end-systolic volume index increased from 31 +/- 11 to 55 +/- 23 ml/M2 (+79%, P < 0.01), whereas ejection fraction decreased from 45 +/- 9 to 41 +/- 7% (-9%, P = NS). Averaged regional anterior w all motion improved during the first 4 weeks (11 +/- 10 to 16 +/- 12%) , but subsequently deteriorated (16 +/- 12 to 10 +/- 6, P < 0.05). The number of segments with pathological wall motion increased. Similar v olumetric and regional wall motion data were demonstrated in inferior wall infarction. We believe this reflects a chronic ventricular remode lling phenomenon. This process takes place predominantly during the fi rst 3 months, but continues over the whole follow-up period. Forty per cent of the patients suffered symptoms of heart failure on long-term f ollow-up. Attenuation of progressive ventricular enlargement remains a therapeutic challenge in the long-term care of these patients. Angiot ensin-converting enzyme inhibitors are promising agents in this regard .