Assessment of infarct characteristics and left ventricular function on serial CMR in STEMI patients treated with...

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Sonothrombolysis is explored as an adjunctive therapy for ST-elevation myocardial infarction (STEMI) to minimize infarct size (IS) and preserve left ventricular (LV) function.
• Previous randomized clinical trials have investigated its efficacy, but further assessment of infarct characteristics and LV function using cardiovascular magnetic resonance (CMR) is warranted.

Purpose of the Study:

• To evaluate the impact of sonothrombolysis following primary percutaneous coronary intervention (PCI) on infarct characteristics and LV function in STEMI patients.
• To assess changes in infarct size, distribution, microvascular obstruction, and myocardial hemorrhage using CMR imaging.

Main Methods:

• Fifty-two STEMI patients were randomized to receive sonothrombolysis post-PCI.
• Early (within 7 days) and follow-up (6-8 weeks) CMR imaging were performed to assess IS, LV global longitudinal strain (GLS), and LV ejection fraction (LVEF).
• T1/T2-mapping was utilized to evaluate infarct and remote zone characteristics.

Main Results:

• While no significant differences in IS were observed between groups at baseline or follow-up, the sonothrombolysis group showed a significantly different infarct pattern (patchy LGE) on early CMR (46% vs. 19%, p=0.04).
• The sonothrombolysis group demonstrated significant improvements in LVEF (ΔLVEF: 7.2 ± 5.4%, p<0.01) and GLS (|ΔGLS|: 3.2 ± 3.2%, p<0.01) compared to the control group.
• No significant improvement in LVEF or GLS was noted in the control group.

Conclusions:

• Post-PCI sonothrombolysis in STEMI patients leads to improved LV systolic function at 6-8 weeks.
• This functional improvement is independent of reductions in infarct size.
• Further research is needed to explore the effects of sonothrombolysis on infarct zone viability.