Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles
Carregando...
Citações na Scopus
64
Tipo de produção
article
Data de publicação
2016
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCIENCE INC
Citação
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v.67, n.21, p.2506-2515, 2016
Resumo
BACKGROUND 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.
Palavras-chave
acute myocardial infarction, microvascular obstruction, ultrasound therapy
Referências
- Tsutsui JM, 2005, CIRCULATION, V112, P1444, DOI 10.1161/CIRCULATIONHA.105.537134
- ITO H, 1992, CIRCULATION, V85, P1699
- Leeman JE, 2012, ULTRASOUND MED BIOL, V38, P1589, DOI 10.1016/j.ultrasmedbio.2012.05.020
- Caldas MA, 2004, J AM SOC ECHOCARDIOG, V17, P923, DOI 10.1016/j.echo.2004.05.016
- Miller DL, 2006, J AM COLL CARDIOL, V47, P1464, DOI 10.1016/j.jacc.2005.09.078
- Leong-Poi H, 2001, J AM SOC ECHOCARDIOG, V14, P1173, DOI 10.1067/mje.2001.115982
- Xie F, 2009, JACC-CARDIOVASC IMAG, V2, P511, DOI 10.1016/j.jcmg.2009.02.002
- Xie F, 2011, J AM SOC ECHOCARDIOG, V24, P1400, DOI 10.1016/j.echo.2011.09.007
- Niccoli G, 2009, J AM COLL CARDIOL, V54, P281, DOI 10.1016/j.jacc.2009.03.054
- Nicolau JC, 2003, AM J CARDIOL, V91, P451, DOI 10.1016/S0002-9149(02)03245-9
- Hoffmann R, 2006, J AM COLL CARDIOL, V47, P121, DOI 10.1016/j.jacc.2005.10.012
- Pollack CV, 2008, ANN EMERG MED, V51, P591, DOI 10.1016/j.annemergmed.2007.09.004
- Mozaffarian D, 2016, CIRCULATION, V133, pE38, DOI 10.1161/CIR.0000000000000350
- Sezer M, 2004, HEART, V90, P146, DOI 10.1136/hrt.2002.009985
- Ross AM, 2005, J AM COLL CARDIOL, V45, P1775, DOI 10.1016/j.jacc.2005.02.061
- KENNER MD, 1995, AM J CARDIOL, V76, P861, DOI 10.1016/S0002-9149(99)80250-1
- Trindade MLZH, 2007, J AM SOC ECHOCARDIOG, V20, P126, DOI 10.1016/j.echo.2006.08.022
- Xie F, 2009, CIRCULATION, V119, P1378, DOI 10.1161/CIRCULATIONAHA.108.825067
- Ay T, 2001, CIRCULATION, V104, P461, DOI 10.1161/hc3001.092038
- Wu JF, 2014, ULTRASOUND MED BIOL, V40, P1545, DOI 10.1016/j.ultrasmedbio.2014.01.015
- Porter TR, 2011, CIRC-CARDIOVASC IMAG, V4, P628, DOI 10.1161/CIRCIMAGING.111.966341
- Pacella JJ, 2015, ULTRASOUND MED BIOL, V41, P456, DOI 10.1016/j.ultrasmedbio.2014.09.033
- Siegel RJ, 2004, J AM COLL CARDIOL, V44, P1454, DOI 10.1016/j.jacc.2004.06.062
- Bazzino O, 2011, AM HEART J, V162, P852
- Belcik JT, 2015, CIRC CARDIOVASC IMAG, V8
- Lang RM, 2015, J AM SOC ECHOCARDIOG, V28, P1, DOI 10.1016/j.echo.2014.10.003
- O'Gara PT, 2013, J AM COLL CARDIOL, V61, pE78, DOI 10.1016/j.jacc.2012.11.019
- TIMI Study Group, 1985, NEW ENGL J MED, V312, P932
- Xie F, 2013, PLOS ONE, V8, DOI 10.1371/journal.pone.0069780