State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Cardiac Internal Medicine, Shenzhen Sun Yat-Sen Cardiovascular Hospital, Shenzhen, China.
Crit Care Med. 2018 Sep;46(9):e912-e920. doi: 10.1097/CCM.0000000000003255.
Effective treatment for microvascular thrombosis-induced coronary no-reflow remains an unmet clinical need. This study sought to evaluate whether diagnostic ultrasound and microbubbles treatment could improve outcomes of coronary no-reflow by dissolving platelet- and erythrocyte-rich microthrombi.
Randomized controlled laboratory investigation.
Research laboratory.
Mongrel dogs.
Coronary no-reflow models induced by platelet- or erythrocyte-rich microthrombi were established and randomly assigned to control, ultrasound, recombinant tissue-type plasminogen activator, ultrasound + microbubbles, or ultrasound + microbubbles + recombinant tissue-type plasminogen activator group. All treatments lasted for 30 minutes.
Percentage of microemboli-obstructed coronary arterioles was lower in ultrasound + microbubbles group than that in control group for platelet- (> 50% obstruction: 10.20% ± 3.56% vs 31.80% ± 3.96%; < 50% obstruction: 14.80% ± 4.15% vs 28.20% ± 3.56%) and erythrocyte-rich microthrombi (> 50% obstruction: 8.20% ± 3.11% vs 30.60% ± 4.83%; < 50% obstruction: 12.80% ± 4.15% vs 25.80% ± 3.70%) (p < 0.001). Percentage change of myocardial blood flow in left anterior descending artery-dominated region, left ventricular ejection fraction, fractional shortening, and ST-segment resolution were higher, whereas infarcted area, troponin I, and creatine kinase MB isoenzyme were lower in ultrasound + microbubbles group than that in control group for both types of microthrombi (p < 0.001). Percentage change of myocardial blood flow, ejection fraction, fractional shortening, and ST-segment resolution were higher, whereas infarcted area, troponin I, and creatine kinase MB isoenzyme were lower in ultrasound + microbubbles and ultrasound + microbubbles + recombinant tissue-type plasminogen activator groups than that in recombinant tissue-type plasminogen activator group for platelet-rich microthrombi (p < 0.05).
Ultrasound + microbubbles treatment could dissolve platelet- and erythrocyte-rich microthrombi, thereby improving outcomes of coronary no-reflow, making it a promising supplement to current reperfusion therapy for acute ST-segment elevation myocardial infarction.
有效治疗微血管血栓引起的无复流仍然是临床未满足的需求。本研究旨在评估诊断性超声联合微泡治疗是否可以通过溶解富含血小板和红细胞的微血栓来改善无复流的结局。
随机对照实验室研究。
研究实验室。
杂种狗。
通过富含血小板或红细胞的微血栓建立无复流模型，并随机分为对照组、超声组、重组组织型纤溶酶原激活剂组、超声+微泡组和超声+微泡+重组组织型纤溶酶原激活剂组。所有治疗持续 30 分钟。
超声+微泡组富含血小板的微血栓阻塞冠状动脉小动脉的微栓塞百分比低于对照组（> 50% 阻塞：10.20% ± 3.56% vs 31.80% ± 3.96%；< 50% 阻塞：14.80% ± 4.15% vs 28.20% ± 3.56%）和富含红细胞的微血栓（> 50% 阻塞：8.20% ± 3.11% vs 30.60% ± 4.83%；< 50% 阻塞：12.80% ± 4.15% vs 25.80% ± 3.70%）（p < 0.001）。左前降支主导区域的心肌血流百分比变化、左心室射血分数、缩短分数和 ST 段分辨率升高，而梗死面积、肌钙蛋白 I 和肌酸激酶同工酶 MB 降低在超声+微泡组与对照组均低于对照组两种类型的微血栓（p < 0.001）。超声+微泡组和超声+微泡+重组组织型纤溶酶原激活剂组的心肌血流百分比变化、射血分数、缩短分数和 ST 段分辨率均高于重组组织型纤溶酶原激活剂组，而富含血小板的微血栓组的梗死面积、肌钙蛋白 I 和肌酸激酶同工酶 MB 降低（p < 0.05）。
超声+微泡治疗可以溶解富含血小板和红细胞的微血栓，从而改善无复流的结局，成为急性 ST 段抬高型心肌梗死再灌注治疗的一种有前途的补充方法。
