Clinical InvestigationsNovel Roles for Ultrasound Enhancing AgentsThe Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients With ST Elevation Acute Myocardial Infarction
Section snippets
Study Protocol
As previously described, the MRUSMI trial (ClinicalTrials.gov no. NCT02410330) was designed to assess the effect of sonothrombolysis to improve coronary angiographic and microvascular reflow in patients with first STEMI.10,11 From May 2014 through July 2018, 100 patients were randomized into 2 groups: a therapy group assigned to receive high MI (1.8 MHz; 1.1-1.3 MI; <5 μsec pulse duration) impulses during an intravenous microbubbles infusion (sonothrombolysis) before and after emergent PCI and
Baseline Characteristics
Between May 2014 and July 2018, a total of 100 prospectively enrolled patients included in the MRUSMI trial were randomized into the control or therapy group. Some patients died during the follow-up, and at the end of our study, we had 44 patients in each group with completed data during the follow-up. The numbers of patients in the control and therapy groups was, respectively, before PCI 50 versus 50, after PCI 49 versus 50, at 48 to 72 hours 47 versus 49, at 1 month 46 versus 44, and at
Discussion
The present study, based on the first randomized clinical trial in humans to evaluate the impact of sonothrombolysis on LV diastolic function (LVDF), LA mechanics and remodeling in patients with acute STEMI, identified several novel findings.
The reduction of STEMI complications, such as adverse cardiac remodeling that leads to heart failure, is intrinsically related to the restoration of coronary blood flow. In light of this, previous studies have shown the effects of sonothrombolysis on
Conclusion
In patients with acute STEMI treated with sonothrombolysis before and after emergent PCI, there was an early and persistent improvement in the LA-GLS and the LVDF and a decrease in LA remodeling, demonstrating the short- and long-term benefit of this emerging therapy. Further studies are needed to introduce this new therapy into clinical practice.
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Conflicts of Interest: None.
This work was supported by a grant from “Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), São Paulo, Brazil.” The funding for study coordinators was provided by the Theodore F. Hubbard Foundation from the University of Nebraska Medical Center. The funding resources played no role in the design, conduct, or reporting of the present study.