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

Wilson Mathias, Jeane M. Tsutsui, Bruno G. Tavares, Feng Xie, Miguel O D Aguiar, Diego R. Garcia, Mucio T. Oliveira, Alexandre Soeiro, Jose C. Nicolau, Pedro A. Lemos, Carlos E. Rochitte, José A F Ramires, Roberto Kalil, Thomas Richard Porter

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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)

Original languageEnglish (US)
Pages (from-to)2506-2515
Number of pages10
JournalJournal of the American College of Cardiology
Volume67
Issue number21
DOIs
StatePublished - May 31 2016

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Microbubbles
Percutaneous Coronary Intervention
Ultrasonography
Myocardial Infarction
perflutren
Transducers

Keywords

  • acute myocardial infarction
  • microvascular obstruction
  • ultrasound therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients with STEMI Receiving Intravenous Microbubbles. / Mathias, Wilson; Tsutsui, Jeane M.; Tavares, Bruno G.; Xie, Feng; Aguiar, Miguel O D; Garcia, Diego R.; Oliveira, Mucio T.; Soeiro, Alexandre; Nicolau, Jose C.; Lemos, Pedro A.; Rochitte, Carlos E.; Ramires, José A F; Kalil, Roberto; Porter, Thomas Richard.

In: Journal of the American College of Cardiology, Vol. 67, No. 21, 31.05.2016, p. 2506-2515.

Research output: Contribution to journalArticle

Mathias, W, Tsutsui, JM, Tavares, BG, Xie, F, Aguiar, MOD, Garcia, DR, Oliveira, MT, Soeiro, A, Nicolau, JC, Lemos, PA, Rochitte, CE, Ramires, JAF, Kalil, R & Porter, TR 2016, 'Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients with STEMI Receiving Intravenous Microbubbles', Journal of the American College of Cardiology, vol. 67, no. 21, pp. 2506-2515. https://doi.org/10.1016/j.jacc.2016.03.542
Mathias, Wilson ; Tsutsui, Jeane M. ; Tavares, Bruno G. ; Xie, Feng ; Aguiar, Miguel O D ; Garcia, Diego R. ; Oliveira, Mucio T. ; Soeiro, Alexandre ; Nicolau, Jose C. ; Lemos, Pedro A. ; Rochitte, Carlos E. ; Ramires, José A F ; Kalil, Roberto ; Porter, Thomas Richard. / Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients with STEMI Receiving Intravenous Microbubbles. In: Journal of the American College of Cardiology. 2016 ; Vol. 67, No. 21. pp. 2506-2515.
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AU - Mathias, Wilson

AU - Tsutsui, Jeane M.

AU - Tavares, Bruno G.

AU - Xie, Feng

AU - Aguiar, Miguel O D

AU - Garcia, Diego R.

AU - Oliveira, Mucio T.

AU - Soeiro, Alexandre

AU - Nicolau, Jose C.

AU - Lemos, Pedro A.

AU - Rochitte, Carlos E.

AU - Ramires, José A F

AU - Kalil, Roberto

AU - Porter, Thomas Richard

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N2 - 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)

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