HSU PO CHIANG
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conferenceObject EFFECT OF TICAGRELOR AND CLOPIDOGREL ON CORONARY MICROCIRCULATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION(2019) SCANAVINI FILHO, Marco Antonio; BERWANGER, Otavio; MATHIAS JUNIOR, Wilson; AGUIAR, Miguel Osman; CHIANG, Hsu Po; BARACIOLI, Luciano Moreira; LIMA, Felipe Gallego; MENEZES, Fernando Reis; DALCOQUIO, Talia; FURTADO, Remo Holanda M.; LUCA, Fabio Augusto De; UEZATO, Delcio; RAMIRES, Jose Antonio Franchini; KALIL FILHO, Roberto; NICOLAU, Jose CarlosconferenceObject Sonothrombolysis Improves Left Atrial Pressure and Volume in Patients With ST Elevation Acute Myocardial Infarction(2020) CHIANG, Hsu Po; AGUIAR, Miguel; TAVARES, Bruno; MATHIAS, Wilson; BORGES, Bruno C.; OLIVEIRA, Mucio; SOEIRO, Alexandre D.; NICOLAU, Jose C.; SBANO, Joao; GOLDSWEIG, Andrew M.; KALIL FILHO, Roberto; RAMIRES, Jose A.; PORTER, Thomas R.; TSUTSUI, Jeane M.conferenceObject THE IMPACT OF SONOTHROMBOLYSIS ON LEFT VENTRICULAR DIASTOLIC FUNCTION AND LEFT ATRIAL MECHANICS IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION(2020) CHIANG, Hsu; AGUIAR, Miguel Osman; TAVARES, Bruno Garcia; MATHIAS JR., Wilson; BORGES, Bruno Carter; AZEVEDO, Luciene; OLIVEIRA, Mucio; SOEIRO, Alexandre; NICOLAU, Jose C.; RIBEIRO, Henrique B.; SBANO, Joao Cesar; GOLDSWEIG, Andrew; KALIL-FILHO, Roberto; RAMIRES, Jose; PORTER, Thomas; TSUTSUI, Jeane- Sonothrombolysis Promotes Improvement in Left Ventricular Wall Motion and Perfusion Scores after Acute Myocardial Infarction(2022) TAVARES, Bruno G.; AGUIAR, Miguel Osman; TSUTSUI, Jeane; OLIVEIRA, Mucio; SOEIRO, Alexandre de Matos; NICOLAU, Jose; RIBEIRO, Henrique; POCHIANG, Hsu; SBANO, Joao; ROCHITTE, Carlos Eduardo; LOPES, Bernardo; RAMIREZ, Jose; KALIL FILHO, Roberto; MATHIAS, WilsonBackground: It has recently been demonstrated that the application of high-energy ultrasound and microbubbles, in a technique known as sonothrombolysis, dissolves intravascular thrombi and increases the angiographic recanalization rate in patients with ST-segment-elevation myocardial infarction (STEMI). Objective: To evaluate the effects of sonothrombolysis on left ventricular wall motion and myocardial perfusion in patients with STEMI, using real-time myocardial perfusion echocardiography (RTMPE). Methods: One hundred patients with STEMI were randomized into the following 2 groups: therapy (50 patients treated with sonothrombolysis and primary coronary angioplasty) and control (50 patients treated with primary coronary angioplasty). The patients underwent RTMPE for analysis of left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and number of segments with myocardial perfusion defects 72 hours after STEMI and at 6 months of follow-up. P < 0.05 was considered statistically significant. Results: Patients treated with sonothrombolysis had higher LVEF than the control group at 72 hours (50% +/- 10% versus 44% +/- 10%; p = 0.006), and this difference was maintained at 6 months of follow-up (53% +/- 10% versus 48% +/- 12%; p = 0.008). The WMSI was similar in the therapy and control groups at 72 hours (1.62 +/- 0.39 versus 1.75 +/- 0.40; p = 0.09), but it was lower in the therapy group at 6 months (1.46 +/- 0.36 versus 1.64 +/- 0.44; p = 0.02). The number of segments with perfusion defects on RTMPE was similar in therapy and control group at 72 hours (5.92 +/- 3.47 versus 6.94 +/- 3.39; p = 0.15), but it was lower in the therapy group at 6 months (4.64 +/- 3.31 versus 6.57 +/- 4.29; p = 0.01). Conclusion: Sonothrombolysis in patients with STEMI resulted in improved wall motion and ventricular perfusion scores over time.
- Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention(2019) JR, Wilson Mathias; TSUTSUI, Jeane M.; TAVARES, Bruno G.; FAVA, Agostina M.; AGUIAR, Miguel O. D.; BORGES, Bruno C.; JR, Mucio T. Oliveira; SOEIRO, Alexandre; NICOLAU, Jose C.; RIBEIRO, Henrique B.; CHIANG, Hsu Po; SBANO, Joao C. N.; MORAD, Abdulrahman; GOLDSWEIG, Andrew; ROCHITTE, Carlos E.; LOPES, Bernardo B. C.; RAMIREZ, Jose A. F.; KALIL FILHO, Roberto; PORTER, Thomas R.BACKGROUND Preclinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES This study tested the clinical effectiveness of sonothrombolysis in patients with STEMI. METHODS Patients with their first STEMI were prospectively randomized to either diagnostic ultrasound-guided high MI impulses during an intravenous Definity (Lantheus Medical Imaging, North Billerica, Massachusetts) infusion before, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (n = 50 in each group). A reference first STEMI group (n = 203) who arrived outside the randomization window was also analyzed. Angiographic recanalization before PCI, ST-segment resolution, infarct size by magnetic resonance imaging, and systolic function (LVEF) at 6 months were compared. RESULTS ST-segment resolution occurred in 16 (32%) high MI PCI versus 2 (4%) PCI-only patients before PCI, and angiographic recanalization was 48% in high MI/PCI versus 20% in PCI only and 21% in the reference group (p < 0.001). Infarct size was reduced (29 +/- 22 g high MI/PCI vs. 40 +/- 20 g PCI only; p = 0.026). LVEF was not different between groups before treatment (44 +/- 11% vs. 43 +/- 10%), but increased immediately after PCI in the high MI/PCI group (p = 0.03), and remained higher at 6 months (p = 0.015). Need for implantable defibrillator (LVEF <= 30%) was reducedin the high MI/PCI group (5% vs. 18% PCI only; p = 0.045). CONCLUSIONS Sonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (C) 2019 by the American College of Cardiology Foundation.
conferenceObject Sonothrombolysis Improves Myocardial Dynamics and Microvascular Obstruction Preventing Left Ventricular Remodeling in Patients With ST Elevation Myocardial Infarction(2019) AGUIAR, Miguel O.; TSUTSUI, Jeane; TAVARES, Bruno G.; LOPES, Bernardo B. C.; NICOLAU, Jose; CHIANG, Hsu Po; PORTER, Thomas; BORGES, Bruno Carter C.; SOEIRO, Alexandre; OLIVEIRA JR., Mucio T.; ROCHITTE, Carlos; RAMIRES, Jose A. F.; KALIL, Roberto; MATHIAS, Wilson- Sonothrombolysis Improves Myocardial Dynamics and Microvascular Obstruction Preventing Left Ventricular Remodeling in Patients With ST Elevation Myocardial Infarction(2020) AGUIAR, Miguel O. D.; TAVARES, Bruno G.; TSUTSUI, Jeane M.; FAVA, Agostina M.; BORGES, Bruno C.; OLIVEIRA JR., Mucio T.; SOEIRO, Alexandre; NICOLAU, Jose C.; RIBEIRO, Henrique B.; CHIANG, Hsu P.; SBANO, Joao C. N.; GOLDSWEIG, Andrew; ROCHITTE, Carlos E.; LOPES, Bernardo B. C.; RAMIREZ, Jose A. F.; KALIL FILHO, Roberto; PORTER, Thomas R.; MATHIAS JR., WilsonBackground: 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.
- The Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients With ST Elevation Acute Myocardial Infarction(2023) CHIANG, Hsu Po; AGUIAR, Miguel O. D.; TAVARES, Bruno G.; ROSA, Vitor E. E.; GOMES, Sergio Barros; OLIVEIRA, Mucio T.; SOEIRO, Alexandre; NICOLAU, Jose C.; RIBEIRO, Henrique B.; SBANO, Joao C.; ROCHITTE, Carlos E.; FILHO, Roberto Kalil; RAMIRES, Jose A. F.; PORTER, Thomas R.; MATHIAS, Wilson; TSUTSUI, Jeane M.Background: The diagnostic ultrasound-guided high mechanical index impulses during an intravenous micro -bubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics. Methods: One hundred patients (59 +/- 10 years; 34% women) were randomized to receive either high mechan-ical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were clas-sified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography-derived global longitudinal strain (GLS).Results: As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incre-mentally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% +/- 7.3% in the therapy group versus 19.6% +/- 7.2% in the control group, P = .005; at 1 month, 25.3% +/- 6.3% in the ther-apy group versus 21.5% +/- 8.3% in the control group, P = .020; and at 6 months, 26.2% +/- 8.7% in the therapy group versus 21.6% +/- 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006).Conclusion: Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodel-ing. (J Am Soc Echocardiogr 2023;36:504-13.)