Abstract 9667: Sonothrombolysis Improves Myocardial Dynamics and Microvascular Obstruction Preventing Left Ventricular Remodeling in Patients With ST Elevation Myocardial Infarction

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A9667
• Main Authors: Aguiar, Miguel O, Tsutsui, Jeane, Tavares, Bruno G, B. C. Lopes, Bernardo, Nicolau, Jose, Po Chiang, Hsu, Porter, Thomas, C. Borges, Bruno Carter, Soeiro, Alexandre, T. Oliveira, Múcio, Rochitte, Carlos, A. F Ramires, José, Kalil, Roberto, Mathias, Wilson
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19-11-2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.9667

IntroductionIt 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 (STEMI).ObjectiveWe sought to study the effect of sonothrombolysis on the myocardial dynamics and infarct size obtained by real-time myocardial perfusion echocardiography (RTMPE) and their value in preventing left ventricular remodeling (LVR).Methods100 patients with STEMI were randomized into therapy [50 patients treated with sonothrombolysis and percutaneous coronary intervention (PCI)] and control (50 patients treated with PCI). Left ventricular volumes, ejection fraction, risk area (prior to treatment), myocardial perfusion defect over time (infarct size) and global longitudinal strain (LV-GLS) were determined by quantitative RTMPE and speckle tracking imaging.ResultsRisk area was similar in the control and therapy (19.2±10.1% vs 20.7±8.9%; p=0.56) before treatment. The therapy group presented a behavior significantly different than control over time (p<0.001). The perfusion defect decreased in therapy at 48-72h even in the subgroup of patients with no recanalization at first angiography (12.9±6.5% therapy vs 18.8±9.9% control;p=0.015). The LV-GLS was higher in the therapy than control immediately after PCI (14.1±4.1% vs 12.0±3.3%;p=0.012) and this difference was maintained over time until 6 months (17.1±3.5% vs 13.6±3.6%;p<0.001). The only predictor of LVR was treatment with sonothrombolysis. The control group was more likely to exhibit LVR with an odds ratio of 2.79 (95%CI=0.13-6.86;p=0.026).ConclusionSonothrombolysis reduces microvascular obstruction and improves myocardial dynamics in patients with STEMI, and is an independent predictor of LVR over time.