Related Experiment Videos
Use of left ventricular function as an end point of thrombolytic therapy
J P Bassand1, T Anguenot, J Cassagnes
1Centre Hospitalier Universitaire, Besançon, France.
Insights
Early reperfusion therapy for acute myocardial infarction significantly limits infarct size, preserving left ventricular function. This improves outcomes by reducing scar tissue and preventing adverse cardiac remodeling.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Acute myocardial infarction (AMI) can lead to significant myocardial damage and impaired left ventricular function.
- Early reperfusion of the infarct-related artery is crucial for salvaging myocardium and limiting infarct size.
Purpose of the Study:
- To evaluate the efficacy of thrombolytic therapy in limiting infarct size and preserving left ventricular function in patients with acute myocardial infarction.
- To compare the effectiveness of different thrombolytic agents, specifically anistreplase, against conventional heparin therapy and other thrombolytics like alteplase.
Main Methods:
- Review of clinical trials comparing thrombolytic agents (streptokinase, alteplase, anistreplase) with placebo or conventional therapy (heparin).
- Assessment of infarct size using single photon emission computed tomography (SPECT).
- Measurement of left ventricular ejection fraction (LVEF) to evaluate cardiac function.
Main Results:
- Early reperfusion therapy significantly limits infarct size and preserves left ventricular ejection fraction.
- Anistreplase demonstrated a 31% reduction in infarct size compared to heparin therapy.
- Anistreplase showed comparable efficacy to alteplase in preserving LVEF and limiting infarct size.
Conclusions:
- Thrombolytic therapy, including anistreplase, is effective in limiting infarct size and preserving left ventricular function in acute myocardial infarction.
- Early reperfusion is key to reducing myocardial damage, preventing adverse ventricular remodeling, and improving long-term cardiac outcomes.
- Anistreplase offers a viable therapeutic option comparable to alteplase for infarct size limitation and LVEF preservation.
Abstract:
In recent acute myocardial infarction, early reperfusion of the infarct-related artery by intracoronary or intravenous thrombolytic therapy induces a significant limitation of infarct size, provided reperfusion occurs within a time frame that myocardial salvage can still be expected. Limitation of infarct size reduces scar tissue formation, aneurysm formation, infarct zone expansion, left ventricular volume enlargement, and eventually results in higher left ventricular ejection fraction. Infarct size limitation and left ventricular function preservation occur with all thrombolytic agents currently in clinical use: streptokinase, alteplase and, more recently, anistreplase. When anistreplase is compared with conventional heparin therapy, a 31% reduction in infarct size is found (estimated from single photon emission computed tomography, or SPECT). This translates into a significant preservation of left ventricular ejection fraction as observed in anistreplase-treated patients compared with heparin-treated patients (0.53 +/- 0.13 vs 0.47 +/- 0.12, p less than 0.002). In comparative trials of 2 thrombolytic agents, anistreplase was demonstrated to be as efficient as alteplase on left ventricular ejection fraction preservation and infarct size limitation.