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

Abstract

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%; P =0.56) before treatment. The therapy group presented a behavior significantly different than control group over time ( P <0.001). The perfusion defect was smaller in the therapy at 48 to 72 hours even in the subgroup of patients with no recanalization at first angiography (12.9±6.5% therapy versus 18.8±9.9% control; P =0.015). The left ventricular global longitudinal strain was higher in the therapy than control immediately after percutaneous coronary intervention (14.1±4.1% versus 12.0±3.3%; P =0.012), and this difference was maintained until 6 months (17.1±3.5% versus 13.6±3.6%; P <0.001). The only predictor of left ventricular remodeling was treatment with sonothrombolysis: the control group was more likely to exhibit left ventricular remodeling with an odds ratio of 2.79 ([95% CI, 0.13–6.86]; P =0.026). 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.

Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound

“…Patients in sonothrombolysis group had a higher recanalization rate and TIMI flow before PCI, and reduced infarct size on CMR, resulting in sustained improvements in LVEF and less need for intracardiac defibrillator placement at 6 months follow-up. Furthermore, a substudy showed improved LV global longitudinal strain and decreased perfusion defect size by MCE at follow up, and the only independent predictor of LV remodeling was treatment with sonothrombolysis ( 106 ). As contrast ultrasound is portable, this technique was also shown to have a promising feasibility of in-ambulance sonothrombolysis for STEMI ( 107 ).…”

Sono-assisted-thrombolysis by three-dimensional diagnostic ultrasound improves epicardial recanalization and microvascular perfusion in acute myocardial infarction

“…Ultrasound-guided thrombolysis is one of the most specific targeted tactics to improve thrombus dissolution. Previous studies have shown that the addition of sonothrombolysis before and after emergency PCI for acute STEMI can immediately improve microvascular flow (22,23). Microbubble cavitation induced by US has both catalytic and flow-inducing properties, and this approach takes advantage of these properties to create flow.…”

Low-Intensity Continuous Ultrasound Therapies—A Systematic Review of Current State-of-the-Art and Future Perspectives

“…A clinical study conducted by Chen et al showed the effectiveness of LIPUS as a combined therapy with alteplase in intravenous thrombosis for vascular recanalization in acute ischemic stroke [ 125 ]. Additionally, Aguiar et al demonstrated the efficacy of LIPUS in reducing microvascular obstruction and improving myocardial dynamics in patients with ST-segment elevation [ 126 ].…”