Sonothrombolysis Improves Myocardial Dynamics and Microvascular Obstruction Preventing Left Ventricular Remodeling in Patients With ST Elevation Myocardial Infarction.

Echocardiography Female Heart / physiopathology Heart Ventricles / diagnostic imaging High-Energy Shock Waves / therapeutic use Humans Magnetic Resonance Imaging Male Mechanical Thrombolysis / methods Microcirculation / physiology Middle Aged Percutaneous Coronary Intervention / methods ST Elevation Myocardial Infarction / physiopathology Treatment Outcome Ventricular Remodeling
angiography control group myocardial infarction odds ratio percutaneous coronary intervention ventricular remodeling

Journal

Circulation. Cardiovascular imaging
ISSN: 1942-0080
Titre abrégé: Circ Cardiovasc Imaging
Pays: United States
ID NLM: 101479935

Informations de publication

Date de publication:
04 2020
Historique:
entrez: 22 4 2020
pubmed: 22 4 2020
medline: 11 11 2020
Statut: ppublish

Résumé

It has recently been demonstrated that high-energy diagnostic transthoracic ultrasound and intravenous microbubbles dissolve thrombi (sonothrombolysis) and increase angiographic recanalization rates in patients with ST-segment-elevation myocardial infarction. We aimed to study the effect of sonothrombolysis on the myocardial dynamics and infarct size obtained by real-time myocardial perfusion echocardiography and their value in preventing left ventricular remodeling. One hundred patients with ST-segment-elevation myocardial infarction were randomized to therapy (50 patients treated with sonothrombolysis and percutaneous coronary intervention) or control (50 patients treated with percutaneous coronary intervention only). Left ventricular volumes, ejection fraction, risk area (before treatment), myocardial perfusion defect over time (infarct size), and global longitudinal strain were determined by quantitative real-time myocardial perfusion echocardiography and speckle tracking echocardiography imaging. Risk area was similar in the control and therapy groups (19.2±10.1% versus 20.7±8.9%; Sonothrombolysis reduces microvascular obstruction and improves myocardial dynamics in patients with ST-segment-elevation myocardial infarction and is an independent predictor of left ventricular remodeling over time.

Sections du résumé

BACKGROUND
It has recently been demonstrated that high-energy diagnostic transthoracic ultrasound and intravenous microbubbles dissolve thrombi (sonothrombolysis) and increase angiographic recanalization rates in patients with ST-segment-elevation myocardial infarction. We aimed to study the effect of sonothrombolysis on the myocardial dynamics and infarct size obtained by real-time myocardial perfusion echocardiography and their value in preventing left ventricular remodeling.
METHODS
One hundred patients with ST-segment-elevation myocardial infarction were randomized to therapy (50 patients treated with sonothrombolysis and percutaneous coronary intervention) or control (50 patients treated with percutaneous coronary intervention only). Left ventricular volumes, ejection fraction, risk area (before treatment), myocardial perfusion defect over time (infarct size), and global longitudinal strain were determined by quantitative real-time myocardial perfusion echocardiography and speckle tracking echocardiography imaging.
RESULTS
Risk area was similar in the control and therapy groups (19.2±10.1% versus 20.7±8.9%;
CONCLUSIONS
Sonothrombolysis reduces microvascular obstruction and improves myocardial dynamics in patients with ST-segment-elevation myocardial infarction and is an independent predictor of left ventricular remodeling over time.

Identifiants

DOI: 10.1161/CIRCIMAGING.119.009536 PMID: 32312114
pubmed: 32312114
doi: 10.1161/CIRCIMAGING.119.009536
doi:

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e009536

Auteurs

Miguel O D Aguiar (MOD)

Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.).

Bruno G Tavares (BG)

Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.).

Jeane M Tsutsui (JM)

Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.).

Agostina M Fava (AM)

University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.).

Bruno C Borges (BC)

Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.).

Mucio T Oliveira (MT)

Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.).

Alexandre Soeiro (A)

Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.).

Jose C Nicolau (JC)

Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.).

Henrique B Ribeiro (HB)

Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.).

Hsu P Chiang (HP)

Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.).

João C N Sbano (JCN)

Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.).

Andrew Goldsweig (A)

University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.).

Carlos E Rochitte (CE)

Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.).

Bernardo B C Lopes (BBC)

Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.).

José A F Ramirez (JAF)

Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.).

Roberto Kalil Filho (R)

Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.).

Thomas R Porter (TR)

University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.).

Wilson Mathias (W)

Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.).

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Classifications MeSH

questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic cardiovasculaire › Tests de la fonction cardiaque › Échocardiographie › Sonothrombolysis Improves Myocardial Dynamics...
questionsmedicales.fr › Système cardiovasculaire › Coeur › Sonothrombolysis Improves Myocardial Dynamics...
questionsmedicales.fr › Système cardiovasculaire › Coeur › Ventricules cardiaques › Sonothrombolysis Improves Myocardial Dynamics...
questionsmedicales.fr › Phénomènes physiques › Rayonnement › Rayonnement non ionisant › Son (physique) › Ondes ultrasonores › Ondes de choc de haute énergie › Sonothrombolysis Improves Myocardial Dynamics...
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