Related Experiment Video
Updated: May 5, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Microvascular recovery with ultrasound in myocardial infarction post-PCI trial
Shouqiang Li1,2, Chad Hovseth1, Feng Xie1
1Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Purpose:
Persistent microvascular obstruction (MVO) after successful percutaneous coronary intervention (PCI) in acute ST segment elevation myocardial infarction (STEMI) has been well-described. MVO predicts lack of recovery of left ventricular function and increased mortality. Sonothrombolysis utilizing diagnostic ultrasound induced cavitation of commercially available microbubble contrast has been effective at reducing infarct size and improving left ventricular ejection fraction (LVEF) when performed both pre- and post-PCI. However, the effectiveness of post-PCI sonothrombolysis alone after successful PCI has not been demonstrated.
Methods:
A prospective randomized controlled trial was performed in 50 consecutive consenting patients with anterior STEMI who underwent a continuous microbubble infusion immediately following successful PCI. Intermittent high mechanical index (MI) impulses were applied only in the sonthrombolysis group. Delayed enhancement magnetic resonance imaging (MRI) was performed at 48 h and again at 6-8 weeks to assess for differences in infarct size, LVEF, and MVO.
Results:
There were no differences between groups in age, gender, and cardiovascular risk factors. Significant (> 2 segments) MVO following successful PCI was observed in 66% of patients. Although sonothrombolysis reduced the extent of MVO acutely, there were no differences in infarct size, LVEF, or extent of MVO by MRI at 48 h. Twenty-eight patients returned for a follow up MRI at 6-8 weeks. LVEF improved only in the sonothrombolysis group (∆LVEF 7.81 ± 4.57% with sonothrombolysis vs. 1.77 ± 7.02% for low MI only, p = .011).
Conclusion:
Post-PCI sonothrombolysis had minimal effect on reducing myocardial infarct size but improved left ventricular systolic function in patients with acute anterior wall STEMI.
Insights
Post-PCI sonothrombolysis improved left ventricular function in STEMI patients but did not reduce infarct size. This therapy offers a potential benefit for cardiac recovery after percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Persistent microvascular obstruction (MVO) after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is linked to poor left ventricular (LV) function recovery and increased mortality.
- Sonothrombolysis, using ultrasound-activated microbubbles, has shown promise in reducing infarct size and improving LV ejection fraction (LVEF) when applied pre- or post-PCI.
Purpose of the Study:
- To evaluate the effectiveness of sonothrombolysis as a standalone therapy immediately following successful PCI in patients with anterior STEMI.
- To determine if post-PCI sonothrombolysis can mitigate MVO and improve cardiac function compared to standard care.
Main Methods:
- A prospective randomized controlled trial involving 50 STEMI patients undergoing successful PCI.
- Patients received continuous microbubble infusion post-PCI; the intervention group received intermittent high mechanical index (MI) impulses (sonothrombolysis).
- Delayed enhancement magnetic resonance imaging (MRI) assessed infarct size, LVEF, and MVO at 48 hours and 6-8 weeks.
Main Results:
- No significant difference in infarct size, LVEF, or MVO was observed at 48 hours between groups.
- At 6-8 weeks, LVEF significantly improved in the sonothrombolysis group (∆LVEF 7.81%) compared to the control group (∆LVEF 1.77%, p=0.011).
- Persistent MVO was observed in 66% of patients post-PCI, with sonothrombolysis showing an acute reduction in MVO extent.
Conclusions:
- Post-PCI sonothrombolysis demonstrated a significant improvement in left ventricular systolic function at 6-8 weeks in anterior STEMI patients.
- The therapy had a minimal impact on reducing myocardial infarct size but enhanced cardiac recovery in this specific patient cohort.
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