Abstract：
OBJECTIVE: Persistent microvascular obstruction (MVO) after successful percutaneous coronary intervention (PCI) in acute ST segment elevation myocardial infarction (STEMI) has been well-described. MVO predicts lack of recovery of left ventricular function and increased mortality. Sonothrombolysis utilizing diagnostic ultrasound induced cavitation of commercially available microbubble contrast has been effective at reducing infarct size and improving left ventricular ejection fraction (LVEF) when performed both pre- and post-PCI. However, the effectiveness of post-PCI sonothrombolysis alone after successful PCI has not been demonstrated.
METHODS: A prospective randomized controlled trial was performed in 50 consecutive consenting patients with anterior STEMI who underwent a continuous microbubble infusion immediately following successful PCI. Intermittent high mechanical index (MI) impulses were applied only in the sonthrombolysis group. Delayed enhancement magnetic resonance imaging (MRI) was performed at 48 h and again at 6-8 weeks to assess for differences in infarct size, LVEF, and MVO.
RESULTS: There were no differences between groups in age, gender, and cardiovascular risk factors. Significant (> 2 segments) MVO following successful PCI was observed in 66% of patients. Although sonothrombolysis reduced the extent of MVO acutely, there were no differences in infarct size, LVEF, or extent of MVO by MRI at 48 h. Twenty-eight patients returned for a follow up MRI at 6-8 weeks. LVEF improved only in the sonothrombolysis group (∆LVEF 7.81 ± 4.57% with sonothrombolysis vs. 1.77 ± 7.02% for low MI only, p = .011).
CONCLUSIONS: Post-PCI sonothrombolysis had minimal effect on reducing myocardial infarct size but improved left ventricular systolic function in patients with acute anterior wall STEMI.
METHODS: A prospective randomized controlled trial was performed in 50 consecutive consenting patients with anterior STEMI who underwent a continuous microbubble infusion immediately following successful PCI. Intermittent high mechanical index (MI) impulses were applied only in the sonthrombolysis group. Delayed enhancement magnetic resonance imaging (MRI) was performed at 48 h and again at 6-8 weeks to assess for differences in infarct size, LVEF, and MVO.
RESULTS: There were no differences between groups in age, gender, and cardiovascular risk factors. Significant (> 2 segments) MVO following successful PCI was observed in 66% of patients. Although sonothrombolysis reduced the extent of MVO acutely, there were no differences in infarct size, LVEF, or extent of MVO by MRI at 48 h. Twenty-eight patients returned for a follow up MRI at 6-8 weeks. LVEF improved only in the sonothrombolysis group (∆LVEF 7.81 ± 4.57% with sonothrombolysis vs. 1.77 ± 7.02% for low MI only, p = .011).
CONCLUSIONS: Post-PCI sonothrombolysis had minimal effect on reducing myocardial infarct size but improved left ventricular systolic function in patients with acute anterior wall STEMI.
摘要：
目的：急性ST段抬高型心肌梗死（STEMI）成功经皮冠状动脉介入治疗（PCI）后持续的微血管阻塞（MVO）已得到充分描述。MVO预测左心室功能缺乏恢复和死亡率增加。在PCI术前和术后进行时，利用诊断超声诱导的市售微泡对比剂空化的超声溶栓可有效减少梗死面积并改善左心室射血分数（LVEF）。然而,PCI成功后,PCI术后超声溶栓的有效性尚未得到证实.
方法：一项前瞻性随机对照试验是对50例连续同意的前部STEMI患者进行的，这些患者在成功PCI后立即接受了连续微泡输注。仅在超声溶栓组中应用间歇性高机械指数（MI）脉冲。延迟增强磁共振成像（MRI）在48小时进行，并在6-8周再次评估梗死面积的差异。LVEF,和MVO。
结果：各组之间的年龄没有差异，性别,和心血管危险因素。在成功的PCI后,在66%的患者中观察到显著的(>2段)MVO。尽管超声溶栓可急剧降低MVO的程度，梗死面积没有差异,LVEF,48h时MRI的MVO或程度。28名患者在6-8周时返回MRI进行随访。仅超声溶栓组的LVEF改善（与超声溶栓相比，LVEF为7.81±4.57％仅低MI为1.77±7.02%，p=.011）。
结论：在急性前壁STEMI患者中，PCI后超声溶栓对减少心肌梗死面积的作用很小，但可改善左心室收缩功能。
方法：一项前瞻性随机对照试验是对50例连续同意的前部STEMI患者进行的，这些患者在成功PCI后立即接受了连续微泡输注。仅在超声溶栓组中应用间歇性高机械指数（MI）脉冲。延迟增强磁共振成像（MRI）在48小时进行，并在6-8周再次评估梗死面积的差异。LVEF,和MVO。
结果：各组之间的年龄没有差异，性别,和心血管危险因素。在成功的PCI后,在66%的患者中观察到显著的(>2段)MVO。尽管超声溶栓可急剧降低MVO的程度，梗死面积没有差异,LVEF,48h时MRI的MVO或程度。28名患者在6-8周时返回MRI进行随访。仅超声溶栓组的LVEF改善（与超声溶栓相比，LVEF为7.81±4.57％仅低MI为1.77±7.02%，p=.011）。
结论：在急性前壁STEMI患者中，PCI后超声溶栓对减少心肌梗死面积的作用很小，但可改善左心室收缩功能。
