Ability of High Intensity Ultrasonic Pulses and Microbubbles to Limit the Extension of Acute Myocardial Infarction: Left Atrial Function

• Grant number: 23/04573-7
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Effective date (Start): May 01, 2023
• Effective date (End): April 30, 2024
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Wilson Mathias Júnior
• Grantee: Derick Meneguetti
• Host Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated research grant: 18/06387-8 - High ultrasound mechanical index and microbubbles to reduce acute myocardial infarction burden I. HUBBLE-I study, AP.TEM

Abstract

Cardiovascular diseases are an important public health problem in Brazil, representing the main cause of death in the country. In this scenario, acute myocardial infarction (AMI), whose main etiology is the acute thrombotic occlusion of a coronary artery, is a clinical event capable of causing sequels in the cardiac microcirculation and, consequently, in the contractile function, which ultimately interfere with the prognosis short and long term. Therefore, the early restoration of coronary flow is an important factor to attenuate the deleterious effects. In addition, after an AMI, as in other cardiovascular conditions, the left atrial pressure, directly reflecting on the pulmonary capillary pressure, is responsible for a significant part of the symptoms, especially when there are signs of failure of the left atrial function. Discrete lesions in left atrial (LA) cells are capable of leading to a process of electrical, functional and architectural remodeling, whose resulting fibrosis adversely affects atrial function. One of the ways to accurately quantify it is to measure its longitudinal strain, which expresses the shortening capacity of the atrial myocardium and can be a viable marker of LA function. Furthermore, during diastole, the LA is exposed to pressure from the left ventricle (LV) in such a way that left ventricular dysfunctions, common after AMI events, can be transfered on to the LA through increased atrial pressure to maintain filling of the LA. LV, which leads to LA dilation and increase in its volume, accelerating the dysfunction process, worsening symptoms and prognosis.In this scenario, sonothrombolysis is an innovative therapy for the rupture of the thrombus formed in an AMI event, promoting the restoration of coronary microcirculation and improving the prognosis of patients. We propose to evaluate the impact of sonothrombolysis on the AE function of patients participating in subprojects 1, 2, 3 and 4 of the HUBBLE I study by comparing patients randomly allocated in the control and therapeutic groups through the evaluation of echocardiographic images already collected.