Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorMATHIAS JR., Wilson
dc.contributor.authorTSUTSUI, Jeane M.
dc.contributor.authorTAVARES, Bruno G.
dc.contributor.authorXIE, Feng
dc.contributor.authorAGUIAR, Miguel O. D.
dc.contributor.authorGARCIA, Diego R.
dc.contributor.authorOLIVEIRA JR., Mucio T.
dc.contributor.authorSOEIRO, Alexandre
dc.contributor.authorNICOLAU, Jose C.
dc.contributor.authorLEMOS NETO, Pedro A.
dc.contributor.authorROCHITTE, Carlos E.
dc.contributor.authorRAMIRES, Jose A. F.
dc.contributor.authorKALIL FILHO, Roberto
dc.contributor.authorPORTER, Thomas R.
dc.date.accessioned2016-07-18T11:48:52Z
dc.date.available2016-07-18T11:48:52Z
dc.date.issued2016
dc.description.abstractBACKGROUND Pre-clinical trials have demonstrated that, during intravenous microbubble infusion, high mechanical index (HMI) impulses from a diagnostic ultrasound (DUS) transducer might restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES The purpose of this study was to test the safety and efficacy of this adjunctive approach in humans. METHODS From May 2014 through September 2015, patients arriving with their first STEMI were randomized to either DUS intermittent HMI impulses (n = 20) just prior to emergent percutaneous coronary intervention (PCI) and for an additional 30 min post-PCI (HMI + PCI), or low mechanical index (LMI) imaging only (n = 10) for perfusion assessments before and after PCI (LMI + PCI). All studies were conducted during an intravenous perflutren lipid microsphere infusion. A control reference group (n = 70) arrived outside of the time window of ultrasound availability and received emergent PCI alone (PCI only). Initial epicardial recanalization rates prior to emergent PCI and improvements in microvascular flow were compared between ultrasound-treated groups. RESULTS Median door-to-dilation times were 82 +/- 26 min in the LMI + PCI group, 72 +/- 15 min in the HMI + PCI group, and 103 +/- 42 min in the PCI-only group (p = NS). Angiographic recanalization prior to PCI was seen in 12 of 20 HMI + PCI patients (60%) compared with 10% of LMI + PCI and 23% of PCI-only patients (p = 0.002). There were no differences in microvascular obstructed segments prior to treatment, but there were significantly smaller proportions of obstructed segments in the HMI + PCI group at 1 month (p = 0.001) and significant improvements in left ventricular ejection fraction (p < 0.005). CONCLUSIONS HMI impulses from a diagnostic transducer, combined with a commercial microbubble infusion, can prevent microvascular obstruction and improve functional outcome when added to the contemporary PCI management of acute STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330) (C) 2016 by the American College of Cardiology Foundation.
dc.description.indexMEDLINE
dc.identifier.citationJOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v.67, n.21, p.2506-2515, 2016
dc.identifier.doi10.1016/j.jacc.2016.03.542
dc.identifier.eissn1558-3597
dc.identifier.issn0735-1097
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/14191
dc.language.isoeng
dc.publisherELSEVIER SCIENCE INC
dc.relation.ispartofJournal of the American College of Cardiology
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER SCIENCE INC
dc.subjectacute myocardial infarction
dc.subjectmicrovascular obstruction
dc.subjectultrasound therapy
dc.subject.otheracute myocardial-infarction
dc.subject.otherleft-ventricular function
dc.subject.otherst-segment resolution
dc.subject.otherperfusion echocardiography
dc.subject.othercontrast echocardiography
dc.subject.otherheart-association
dc.subject.otherno-reflow
dc.subject.othercoronary
dc.subject.otherrecovery
dc.subject.othersonothrombolysis
dc.subject.wosCardiac & Cardiovascular Systems
dc.titleDiagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryisous
hcfmusp.author.externalXIE, Feng:Univ Nebraska Med Ctr, Dept Internal Med, Omaha, NE USA
hcfmusp.author.externalPORTER, Thomas R.:Univ Nebraska Med Ctr, Dept Internal Med, Omaha, NE USA
hcfmusp.citation.scopus66
hcfmusp.contributor.author-fmusphcWILSON MATHIAS JUNIOR
hcfmusp.contributor.author-fmusphcJEANE MIKE TSUTSUI
hcfmusp.contributor.author-fmusphcBRUNO GARCIA TAVARES
hcfmusp.contributor.author-fmusphcMIGUEL OSMAN DIAS AGUIAR
hcfmusp.contributor.author-fmusphcDIEGO RIBEIRO GARCIA
hcfmusp.contributor.author-fmusphcMUCIO TAVARES DE OLIVEIRA JUNIOR
hcfmusp.contributor.author-fmusphcALEXANDRE DE MATOS SOEIRO
hcfmusp.contributor.author-fmusphcJOSE CARLOS NICOLAU
hcfmusp.contributor.author-fmusphcPEDRO ALVES LEMOS NETO
hcfmusp.contributor.author-fmusphcCARLOS EDUARDO ROCHITTE
hcfmusp.contributor.author-fmusphcJOSE ANTONIO FRANCHINI RAMIRES
hcfmusp.contributor.author-fmusphcROBERTO KALIL FILHO
hcfmusp.description.beginpage2506
hcfmusp.description.endpage2515
hcfmusp.description.issue21
hcfmusp.description.volume67
hcfmusp.origemWOS
hcfmusp.origem.pubmed27230046
hcfmusp.origem.scopus2-s2.0-84970016678
hcfmusp.origem.wosWOS:000376336300009
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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hcfmusp.scopus.lastupdate2024-05-17
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