The Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients With ST Elevation Acute Myocardial Infarction.

BACKGROUND: The diagnostic ultrasound-guided high mechanical index impulses during an intravenous microbubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics. METHODS: One hundred patients (59 ± 10 years; 34% women) were randomized to receive either high mechanical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were classified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography-derived global longitudinal strain (GLS). RESULTS: As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incrementally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% ± 7.3% in the therapy group versus 19.6% ± 7.2% in the control group, P = .005; at 1 month, 25.3% ± 6.3% in the therapy group versus 21.5% ± 8.3% in the control group, P = .020; and at 6 months, 26.2% ± 8.7% in the therapy group versus 21.6% ± 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006). CONCLUSION: Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodeling.

Shock-Wave Therapy Improves Myocardial Blood Flow Reserve in Patients with Refractory Angina: Evaluation by Real-Time Myocardial Perfusion Echocardiography.

BACKGROUND: Cardiac shock-wave therapy (CSWT) has been demonstrated as an option for the treatment of patients with refractory angina (RA), promoting immediate vasodilatory effects and, in the long-term, neoangiogenic effects that would be responsible for reducing the myocardial ischemic load. The aim of this study was to determine the effects of CSWT on myocardial blood flow reserve (MBFR) assessed by quantitative real-time myocardial perfusion echocardiography in patients with RA. METHODS: Fifteen patients (mean age 61.5 ± 12.8 years) with RA who underwent CSWT during nine sessions, over 3 months of treatment, were prospectively studied. A total of 32 myocardial segments with ischemia were treated, while another 31 did not receive therapy because of technical limitations. Myocardial perfusion was evaluated at rest and after dipyridamole stress (0.84 mg/kg) before and 6 months after CSWT, using quantitative real-time myocardial perfusion echocardiography. Clinical effects were evaluated using Canadian Cardiovascular Society grading of angina and the Seattle Angina Questionnaire. RESULTS: The ischemic segments treated with CSWT had increased MBFR (from 1.33 ± 0.22 to 1.74 ± 0.29, P < .001), a benefit that was not observed in untreated ischemic segments (1.51 ± 0.29 vs 1.54 ± 0.28, P = .47). Patients demonstrated increased global MBFR (from 1.78 ± 0.54 to 1.89 ± 0.49, P = .017). Semiquantitative single-photon emission computed tomographic analysis of the treated ischemic segments revealed a score reduction from 2.10 ± 0.87 to 1.68 ± 1.19 (P = .024). There was improvement in Canadian Cardiovascular Society score (from 3.20 ± 0.56 to 1.93 ± 0.70, P < .05) and in Seattle Angina Questionnaire score (from 42.3 ± 12.99 to 71.2 ± 14.29, P < .05). No major cardiovascular events were recorded during follow-up. CONCLUSIONS: CSWT improved MBFR in ischemic segments, as demonstrated by quantitative real-time myocardial perfusion echocardiography. These results suggest that CSWT has the potential to increase myocardial blood flow, with an impact on symptoms and quality of life in patients with RA.

Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.

BACKGROUND: Preclinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: This study tested the clinical effectiveness of sonothrombolysis in patients with STEMI. METHODS: Patients with their first STEMI were prospectively randomized to either diagnostic ultrasound-guided high MI impulses during an intravenous Definity (Lantheus Medical Imaging, North Billerica, Massachusetts) infusion before, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (n = 50 in each group). A reference first STEMI group (n = 203) who arrived outside the randomization window was also analyzed. Angiographic recanalization before PCI, ST-segment resolution, infarct size by magnetic resonance imaging, and systolic function (LVEF) at 6 months were compared. RESULTS: ST-segment resolution occurred in 16 (32%) high MI PCI versus 2 (4%) PCI-only patients before PCI, and angiographic recanalization was 48% in high MI/PCI versus 20% in PCI only and 21% in the reference group (p < 0.001). Infarct size was reduced (29 ± 22 g high MI/PCI vs. 40 ± 20 g PCI only; p = 0.026). LVEF was not different between groups before treatment (44 ± 11% vs. 43 ± 10%), but increased immediately after PCI in the high MI/PCI group (p = 0.03), and remained higher at 6 months (p = 0.015). Need for implantable defibrillator (LVEF ≤30%) was reduced in the high MI/PCI group (5% vs. 18% PCI only; p = 0.045). CONCLUSIONS: Sonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330).

Prevalência de diabetes mellitus em pacientes com extrassístoles no eletrocardiograma eletivo

As extrassístoles são as arritmias mais encontradas no eletrocardiograma de repouso e podem ser causadas por cardiopatias estruturais e causas não cardíacas, entre as as quais se destacam os distúrbios metabólicos e/ou eletrolíticos. Este trabalho tem o objetivo de correlacionar os níveis de glicemia de jejum e hemoglobina glicada com extrassístoles no eletrocardiograma de repouso. Para isto foi realizado um estudo com os pacientes que apresentavam extrassístoles no eletrocardiograma de repouso realizado ambulatorialmente no Hospital Municipal do Campo Limpo, no período de janeiro de 2006 a abril de 2008. Estes pacieentes foram convidados a realizar exames de sangue para dosagem de glicemia de jejum (mg/dL) e hemoglobina glicada A1c (%). Aceitaram participar do estudo 328 pacientes com idade média de 62 anos (desvio padrão de 13), dos quais 54,5% eram mulheres. Para comparar com a incidência na população, foi utilizado como grupo controle 123 pacientes que realizaram estes exames ambulatorialmente no mesmo período. Nos pacientes com extrassístoles, foram encontrados 166 pacientes (50.6%) com glicemia =126mg/dL. No grupo controle foram encontrados 51 (41.5%)pacientes com glicemia =126 mg/dL. A hemoglobina glicada era <6.5% em 209 (79.5%) pacientes com extrassístoles e em 104 (84.5%) sem arritmias. Não houve diferença estatística entre pacientes com e sem arritmias. Concluiu-se que o diabetes mellitus não está correlacionado à presença de extrassístole no eletrocardiograma de repouso em pacientes ambulatoriais em nosso estudo.

Prevalência de diabetes mellitus em pacientes com extrassístoles no eletrocardiograma eletivo / Prevalence of diabetes mellitus in patients with premature elective ECG

As extrassístoles são as arritmias mais encontradas no eletrocardiograma de repouso e podem ser causadas por cardiopatias estruturais e causas não cardíacas, entre as as quais se destacam os distúrbios metabólicos e/ou eletrolíticos. Este trabalho tem o objetivo de correlacionar os níveis de glicemia de jejum e hemoglobina glicada com extrassístoles no eletrocardiograma de repouso. Para isto foi realizado um estudo com os pacientes que apresentavam extrassístoles no eletrocardiograma de repouso realizado ambulatorialmente no Hospital Municipal do Campo Limpo, no período de janeiro de 2006 a abril de 2008. Estes pacieentes foram convidados a realizar exames de sangue para dosagem de glicemia de jejum (mg/dL) e hemoglobina glicada A1c (%). Aceitaram participar do estudo 328 pacientes com idade média de 62 anos (desvio padrão de 13), dos quais 54,5% eram mulheres. Para comparar com a incidência na população, foi utilizado como grupo controle 123 pacientes que realizaram estes exames ambulatorialmente no mesmo período. Nos pacientes com extrassístoles, foram encontrados 166 pacientes (50.6%) com glicemia <100 mg/dL, 109 (33.2%) entre 100 e 125 mg/dL, e 53 (16.2%) >=126mg/dL. No grupo controle foram encontrados 51 (41.5%)pacientes com glicemia <100 mg/dL, 50 (40.6%) entre 100 e 125 mg/dL, e 22 (17.9%) >=126 mg/dL. A hemoglobina glicada era <6.5% em 209 (79.5%) pacientes com extrassístoles e em 104 (84.5%) sem arritmias. Não houve diferença estatística entre pacientes com e sem arritmias. Concluiu-se que o diabetes mellitus não está correlacionado à presença de extrassístole no eletrocardiograma de repouso em pacientes ambulatoriais em nosso estudo. (AU)