The influence of thrombolytic therapy on clinical and instrumental parameters of left ventricular remodeling in the late post-infarction period of myocardial infarction with Q-wave

Aim. To evaluate clinical and instrumental parameters of late left ventricular remodeling in patients with myocardial infarction with Q-wave depending on use of thrombolysis. Methods. 87 patients with myocardial infarction with Q-wave on electrocardiography (ECG) were included. First group consisted of 34 patients in whom thrombolytic therapy was performed, second group consisted of 53 patients in whom thrombolysis was not used due to late referral (over 12 hours from initial symptom onset, 88,7%), concomitant hemorrhagic stroke (3,8%), previously reported uncontrolled arterial hypertension (7,6%). All patients were followed up at 3-4 weeks, 60 and 120 months after the onset of myocardial infarction, examination included ECG, echocardiography, clinical examination. Results. In patients of both groups increase of total R-wave amplitude on repetitive ECGs was associated with relative left ventricle wall thickening, increase of left ventricular mass index, decrease of systolic and diastolic wall stresses caused by compensatory hypertrophy of intact cardiomyocytes according to results of correlation analysis. Increase of total amplitude of QS-waves on repetitive ECGs was associated with left ventricular cavity dilatation and spherification with wall thickening, increase of systolic and diastolic wall stresses. Patients in whom thrombolysis was not used had significantly higher rates of angina at post-infarction period. No statistically significant differences of ECG and echocardiography parameters between two groups of patients were found during the whole follow-up period. Non-significant increase of total R-wave amplitude and QS-waves amplitude was registered in patients in whom thrombolysis was started not later than 90 minutes from initial symptom onset compared to patients in whom thrombolysis was started later. Conclusion. Comparison of ECG and echocardiography parameters over time did not reveal any statistically significant differences between the groups with and without thrombolysis.

myocardial infarction, remodeling, thrombolytic therapy, electrocardiography, echocardiography