Abstract 14480: Effects of High Mechanical Index Impulses From a Diagnostic Ultrasound Transducer During an Intravenous Ultrasound Contrast Infusion in Preventing Adverse Left Ventricular Remodeling in Acute ST Segment Myocardial Infarction
Introduction: In patients with acute ST segment elevation myocardial infarction (STEMI), preliminary clinical trials have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound (DUS) transducer during a commercially available ultrasound contrast microbubble (MB) infusion have been shown to improve microvascular flow within the risk area, when administered before and immediately after emergent percutaneous coronary intervention (PCI).
Hypothesis: We hypothesized that this effect of DUS and MB on microvascular flow would prevent adverse left ventricular remodeling (ALVR) at follow up.
Methods: A total of 34 patients with their first acute STEMI (20 left anterior descending, 6 circumflex, 8 right coronary artery) were randomized to randomized to receive an intravenous microbubble (Definity) infusion and either intermittent high MI (1.2) impulses when MB were visualized within myocardial capillaries (high MI + PCI) in each apical window, or low MI imaging alone (PCI only). Treatments were administered just prior to PCI as well for 30 additional minutes following PCI. Recanalization rates prior to PCI and TIMI flow following PCI were compared. ALVR was defined as a >20% increase in left ventricular end diastolic volume at one month follow up.
Results: Door to dilation times were not different between groups (84±28 min PCI only vs 69±16 min in High MI+PCI; p=0.07). However, epicardial recanalization rates prior to PCI were higher in the high MI + PCI group (59% versus 12% PCI only, p<0.05). No significant difference was observed between groups in left ventricular ejection fraction prior to hospital discharge, but ALVR at one month follow up was seen in nine (56%) of the patients treated with PCI only, but only two (14%) patients treated with high MI + PCI (p<0.05).
Conclusions: Intermittent high MI impulses from a DUS transducer during an intravenous commercially available microbubble infusion, applied during the contemporary management of acute STEMI, may prevent adverse left ventricular remodeling at hospital follow up..
Author Disclosures: W. Mathias: None. J.M. Tsutsui: None. B.G. Tavares: None. M.O. Aguiar: None. M.T. Oliveira: None. A. Soeiro: None. P.A. Lemos: None. J. Ramires: None. R. Kalil: None. T.R. Porter: None.
- © 2016 by American Heart Association, Inc.