Assessment of infarct characteristics and left ventricular function on serial CMR in STEMI patients treated with post-PCI sonothrombolysis: post-hoc analysis of two randomized controlled trials

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-07-23 DOI:10.1016/j.ijcha.2025.101757

Soufiane El Kadi , Shouqiang Li , Chad Hovseth , Luuk H.G.A. Hopman , Mariëlle C. van de Veerdonk , Niels J.W. Verouden , Feng Xie , Albert C. van Rossum , Otto Kamp , Thomas R. Porter

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引用次数: 0

Abstract

Background

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..

Methods

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.

Results

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.

Conclusion

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.

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pci后超声溶栓治疗STEMI患者连续CMR的梗死特征和左心室功能评估：两项随机对照试验的事后分析

背景：一些随机临床试验研究了超声溶栓作为st段抬高型心肌梗死（STEMI）患者的辅助治疗，以减少梗死面积（IS）和保持左心室（LV）功能。本研究旨在评估经皮冠状动脉介入治疗（PCI）后行超声溶栓治疗的STEMI患者的梗死特征和左室功能。方法52例STEMI患者在PCI后立即接受超声溶栓治疗，并进行早期（STEMI后7天内）和随访（6-8周）CMR成像。早期CMR评估IS及分布模式、微血管阻塞、心内出血、梗死区及远区T1/ t2作图、左室总纵应变（GLS）、左室射血分数（LVEF）。随访CMR评估左室和左室收缩功能。结果两组患者平均年龄58岁，罪魁动脉均以左前降支为主（分别占92%和93%）。尽管基线和随访时IS没有差异，但早期CMR组之间的梗死模式有显著差异（46%的超声溶栓组斑块状LGE模式vs 19%的对照组，p = 0.04）。LVEF显著改善(ΔLVEF:7.2±5.4%,p <；0.01 vsΔLVEF: 0.9±7.2%,p = 0.29)和gl改进(|Δgl |: 3.2±3.2%,p & lt;在超声溶栓组观察到0.01 vs. |ΔGLS|:1.5±4.2%,p = 0.07)，而在对照组则没有。结论在STEMI后6-8周，行pci后超声溶栓治疗的患者左室收缩功能改善，不依赖于IS降低。需要进一步研究pci后超声溶栓对梗死区生存能力的影响。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.