Abstract 11320: Sonothrombolysis Leads to Early Improvement of Left Ventricular Function in Acute Coronary Syndromes

Abstract

Introduction: Acute coronary syndromes (ACS) are among the main causes of death worldwide. Despite important advances in revascularization strategies, there are a considerable number of patients who neither have access to these therapies, or, if so, may experience the no-reflow phenomenon. In STEMI, sonothrombolysis has been shown to restore patency of coronary vessels, especially in the microcirculation, leading to better left ventricular (LV) function recovery, hence emerging as a new adjuvant treatment to reperfusion. Hypothesis: Sonothrombolysis would improve the LV function in ACS. Aim: Compare ejection fraction (EF) and global longitudinal strain (GLS) in patients with ACS randomized to receive sonothrombolysis (therapy group-TG) or conventional treatment (control group-CG). Methods: Patients were randomized from two major clinical trials (NCT04732091 and NCT02410330 - HUBBLE databank). The therapy consists of high-energy intermittent ultrasound pulses associated with ultrasound-enhancing agent infusion (Definity® - Lantheus), initiated immediately after patient admission and continued after PCI or applied only after PCI for a total of 50 minutes. EF and GLS were measured off-line (TomTec Imaging System). Images were acquired immediately post Therapy/PCI or PCI only and 48/72 hours after the patient's inclusion. Comparisons were made using Student t-test, Chi-square test, and Fisher's exact test when indicated. Results: 120 patients were included (CG=60: 51 STEMI, 1 thrombolyzed STEMI, and 8 NSTEMI; TG=60: 53 STEMI, 1 thrombolyzed STEMI e 6 NSTEMI). Demographic characteristics were similar between groups, except for a tendency of higher number of diabetic patients in TG (43% vs. 25%, p=0.054). EF and GLS were similar between TG and CG immediately post-treatment (Therapy/PCI or PCI only) (47±12 vs. 45±11, p=0.393 and 13.2±4.1 vs. 12.5±3.3, p=0.325, respectively). However, after 48/72 hours, patients who received Therapy/PCI had similar values of EF despite higher GLS (49±10 vs. 46±11, p=0.126 and 13.5±3.8 vs. 11.8±3.1, p=0.010, respectively). Conclusions: Preliminary data shows that Sonothrombolysis associated with PCI could be an effective adjuvant treatment for ACS, contributing to the early improvement of LV function.