Kadi Soufiane El, Li Shouqiang, Hovseth Chad, Hopman Luuk H G A, van de Veerdonk Mariëlle C, Verouden Niels J W, Xie Feng, van Rossum Albert C, Kamp Otto, Porter Thomas R
Amsterdam UMC, Location VUmc, Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
University of Nebraska Medical Center, Division of Cardiovascular Medicine, Omaha, NE, United States.
Int J Cardiol Heart Vasc. 2025 Jul 23;60:101757. doi: 10.1016/j.ijcha.2025.101757. eCollection 2025 Oct.
Several randomized clinical trials have studied sonothrombolysis as adjunctive treatment in ST-elevation myocardial infarction (STEMI) patients to reduce infarct size (IS) and preserve left ventricular (LV) function. This study aims to assess infarct characteristics and LV function in STEMI patients treated with sonothrombolysis following primary percutaneous coronary intervention (PCI) on cardiovascular magnetic resonance (CMR) imaging..
Fifty-two STEMI patients were prospectively randomized to receive sonothrombolysis immediately following PCI and underwent early (within seven days after STEMI) and follow-up (6-8 weeks) CMR imaging. IS and distribution pattern, microvascular obstruction, intramyocardial hemorrhage and T1/T2-mapping of infarct and remote zone, as well as LV global longitudinal strain (GLS) and LV ejection fraction (LVEF) were assessed on early CMR. IS and LV systolic function were also assessed on follow-up CMR.
Mean age was 58 years, and culprit artery was predominately left anterior descending artery in both groups (92 % and 93 %, respectively). Although there were no differences in IS at baseline and follow-up, infarct pattern was significantly different between the groups on early CMR (patchy LGE pattern in 46 % of the sonothrombolysis vs. 19 % control group, p = 0.04). Significant LVEF improvement (ΔLVEF:7.2 ± 5.4 %, p < 0.01 vs ΔLVEF: 0.9 ± 7.2 %, p = 0.29) and GLS improvement (|ΔGLS|: 3.2 ± 3.2 %, p < 0.01 vs. |ΔGLS|:1.5 ± 4.2 %, p = 0.07) was observed in the sonothrombolysis group, but not in the control group.
LV systolic function improvement at 6-8 weeks following STEMI was observed in patients treated with post-PCI sonothrombolysis independent of IS reduction. Further investigation into the effects of post-PCI sonothrombolysis on infarct zone viability is needed.
多项随机临床试验研究了超声溶栓作为辅助治疗手段在ST段抬高型心肌梗死（STEMI）患者中减少梗死面积（IS）和保护左心室（LV）功能的效果。本研究旨在通过心血管磁共振（CMR）成像评估在直接经皮冠状动脉介入治疗（PCI）后接受超声溶栓治疗的STEMI患者的梗死特征和左心室功能。
52例STEMI患者被前瞻性随机分组，在PCI后立即接受超声溶栓治疗，并在早期（STEMI后7天内）和随访期（6 - 8周）接受CMR成像。在早期CMR上评估梗死面积和分布模式、微血管阻塞、心肌内出血以及梗死区和远隔区的T1/T2映射，以及左心室整体纵向应变（GLS）和左心室射血分数（LVEF）。在随访CMR上也评估梗死面积和左心室收缩功能。
平均年龄为58岁，两组罪犯血管均以左前降支为主（分别为92%和93%）。虽然基线和随访时梗死面积无差异，但早期CMR显示两组梗死模式有显著差异（超声溶栓组46%为斑片状延迟强化模式，对照组为19%，p = 0.04）。超声溶栓组观察到左心室射血分数显著改善（ΔLVEF：7.2 ± 5.4%，p < 0.01 vs ΔLVEF：0.9 ± 7.2%，p = 0.29）和整体纵向应变改善（|ΔGLS|：3.2 ± 3.2%，p < 0.01 vs |ΔGLS|：1.5 ± 4.2%，p = 0.07），而对照组未观察到。
在接受PCI后超声溶栓治疗的患者中，观察到STEMI后6 - 8周左心室收缩功能改善，且与梗死面积缩小无关。需要进一步研究PCI后超声溶栓对梗死区存活能力的影响。
