دورية أكاديمية
أعرض في EDS

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

التفاصيل البيبلوغرافية
العنوان: Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles.
المؤلفون: Mathias W Jr; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil. Electronic address: wmathias@incor.usp.br., Tsutsui JM; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Tavares BG; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Xie F; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska., Aguiar MO; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Garcia DR; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Oliveira MT Jr; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Soeiro A; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Nicolau JC; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Lemos PA Neto; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Rochitte CE; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Ramires JA; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Kalil R Filho; Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil., Porter TR; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
المصدر: Journal of the American College of Cardiology [J Am Coll Cardiol] 2016 May 31; Vol. 67 (21), pp. 2506-15.
نوع المنشور: Journal Article; Randomized Controlled Trial
اللغة: English
بيانات الدورية: Publisher: Elsevier Biomedical Country of Publication: United States NLM ID: 8301365 Publication Model: Print Cited Medium: Internet ISSN: 1558-3597 (Electronic) Linking ISSN: 07351097 NLM ISO Abbreviation: J Am Coll Cardiol Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983-
مواضيع طبية MeSH: Microbubbles* , Microcirculation* , Ultrasonic Therapy*, Mechanical Thrombolysis/*methods , ST Elevation Myocardial Infarction/*therapy, Coronary Angiography ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/therapy ; Coronary Circulation ; Coronary Stenosis/diagnostic imaging ; Coronary Stenosis/therapy ; Female ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Stroke Volume
مستخلص: 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).
(Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
التعليقات: Comment in: J Am Coll Cardiol. 2016 May 31;67(21):2516-8. (PMID: 27230047)
Comment in: J Am Coll Cardiol. 2016 Nov 1;68(18):2030-2031. (PMID: 27788861)
Comment in: J Am Coll Cardiol. 2016 Nov 1;68(18):2031-2032. (PMID: 27788862)
فهرسة مساهمة: Keywords: acute myocardial infarction; microvascular obstruction; ultrasound therapy
سلسلة جزيئية: ClinicalTrials.gov NCT02410330
تواريخ الأحداث: Date Created: 20160528 Date Completed: 20170606 Latest Revision: 20170606
رمز التحديث: 20240628
DOI: 10.1016/j.jacc.2016.03.542
PMID: 27230046
قاعدة البيانات: MEDLINE
الوصف
تدمد:1558-3597
DOI:10.1016/j.jacc.2016.03.542