# 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

## TL;DR

This study found that sonothrombolysis after heart attack treatment improved heart function, even without reducing the size of the damaged heart tissue.

## Contribution

The study shows sonothrombolysis improves heart function in STEMI patients independently of infarct size reduction.

## Key findings

- Sonothrombolysis group showed significant improvement in LVEF and GLS compared to the control group.
- Infarct pattern was significantly different between the groups on early CMR.
- LV systolic function improved in sonothrombolysis-treated patients at 6–8 weeks.

## Abstract

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..

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.

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.

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.