High ultrasound mechanical index and microbubbles to reduce acute myocardial infarction burden I. HUBBLE-I study

Abstract

In Brazil, cardiovascular diseases account for approximately 25% of all deaths annually, half of them due to acute coronary syndromes, especially acute myocardial infarction (AMI) and its immediate and mid-term consequences. They account for approximately 50% of the costs of our health care system and even so, access to elective therapies such as primary angioplasty and fibrinolytic therapy does not exceed 40% of those affected. Sonothrombolysis is an innovative therapy, researched by several groups in the world, including ours for more than 15 years and was first applied in humans in Brazil by our group. Sonothrombolysis results from the continuous intravenous infusion of billions of microbubbles with the size of 1/3 of a red blood cell, which intermittently ruptured by high-energy ultrasound, promote the restoration of the coronary microcirculation in acute coronary syndromes. It has the potential to be applied simply and with low risks to the patient by health professionals, with specialized medical support through telemedicine in order to establish the diagnosis of AMI, both in tertiary hospitals and in primary care centers or in ambulances. Moreover, it has the potential to revolutionize all acute thrombotic syndromes as stroke, pulmonary embolism and deep vein thrombosis, among others. In this new study, we propose to advance the knowledge applying this technique in multiple centers, in a wide scenario of acute coronary syndromes, in the pre-hospital, primary and secondary care settings, with the purpose of demonstrating their feasibility, safety and efficacy. Furthermore, the development of a portable, non-imaging ultrasound device prototype, simple-to-handle and capable of generating intermittent ultrasound pulses in order to promote sonothrombolysis is within the scope of this study. Therefore, on long term, this technology has the potential to simplify the treatment of acute thrombotic syndromes in a large scale and pay our society this huge debt in providing the state-of-the-art medical care. (AU)