Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil.
Arq Bras Cardiol. 2022 Apr;118(4):756-765. doi: 10.36660/abc.20200651.
It has recently been demonstrated that the application of high-energy ultrasound and microbubbles, in a technique known as sonothrombolysis, dissolves intravascular thrombi and increases the angiographic recanalization rate in patients with ST-segment-elevation myocardial infarction (STEMI).
To evaluate the effects of sonothrombolysis on left ventricular wall motion and myocardial perfusion in patients with STEMI, using real-time myocardial perfusion echocardiography (RTMPE).
One hundred patients with STEMI were randomized into the following 2 groups: therapy (50 patients treated with sonothrombolysis and primary coronary angioplasty) and control (50 patients treated with primary coronary angioplasty). The patients underwent RTMPE for analysis of left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and number of segments with myocardial perfusion defects 72 hours after STEMI and at 6 months of follow-up. P < 0.05 was considered statistically significant.
Patients treated with sonothrombolysis had higher LVEF than the control group at 72 hours (50% ± 10% versus 44% ± 10%; p = 0.006), and this difference was maintained at 6 months of follow-up (53% ± 10% versus 48% ± 12%; p = 0.008). The WMSI was similar in the therapy and control groups at 72 hours (1.62 ± 0.39 versus 1.75 ± 0.40; p = 0.09), but it was lower in the therapy group at 6 months (1.46 ± 0.36 versus 1.64 ± 0.44; p = 0.02). The number of segments with perfusion defects on RTMPE was similar in therapy and control group at 72 hours (5.92 ± 3.47 versus 6.94 ± 3.39; p = 0.15), but it was lower in the therapy group at 6 months (4.64 ± 3.31 versus 6.57 ± 4.29; p = 0.01).
Sonothrombolysis in patients with STEMI resulted in improved wall motion and ventricular perfusion scores over time.
最近的研究表明，应用高能超声和微泡的技术，即超声溶栓，可溶解血管内血栓，并提高 ST 段抬高型心肌梗死（STEMI）患者的血管再通率。
使用实时心肌灌注超声心动图（RTMPE）评估超声溶栓对 STEMI 患者左心室壁运动和心肌灌注的影响。
100 例 STEMI 患者随机分为以下两组：治疗组（50 例接受超声溶栓和直接经皮冠状动脉介入治疗）和对照组（50 例接受直接经皮冠状动脉介入治疗）。患者在 STEMI 后 72 小时和 6 个月的随访时接受 RTMPE 分析左心室射血分数（LVEF）、壁运动评分指数（WMSI）和心肌灌注缺损节段数。P<0.05 被认为具有统计学意义。
与对照组相比，接受超声溶栓治疗的患者在 72 小时时 LVEF 更高（50%±10%比 44%±10%；p=0.006），并且在 6 个月的随访时仍保持较高水平（53%±10%比 48%±12%；p=0.008）。治疗组和对照组在 72 小时时的 WMSI 相似（1.62±0.39 比 1.75±0.40；p=0.09），但在 6 个月时治疗组较低（1.46±0.36 比 1.64±0.44；p=0.02）。治疗组和对照组在 72 小时时的 RTMPE 灌注缺损节段数相似（5.92±3.47 比 6.94±3.39；p=0.15），但在 6 个月时治疗组较低（4.64±3.31 比 6.57±4.29；p=0.01）。
STEMI 患者的超声溶栓治疗随时间推移改善了壁运动和心室灌注评分。
