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J Am Coll Cardiol, 2004; 44:211, doi:10.1016/j.jacc.2004.04.008
© 2004 by the American College of Cardiology Foundation
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SPECIAL SECTIONS: LETTER TO THE EDITOR

Reply

Robert J. Siegel, MD, FACC*, Huai Luo, MD, Yochai Birnbaum, MD, FACC, Michael C. Fishbein, MD, FACC and Takashi Miyamoto, MD

a Cedars–Sinai Medical Center, Division of Cardiology, 8700 Beverly Boulevard, Room 5335, Los Angeles, CA 90048, USA

siegel{at}cshs.org

We believe the potential benefits of ultrasound include enhancement of thrombolysis, vasodilation, and increased tissue perfusion. Transcutaneous ultrasound in animals facilitates thrombolysis (1). A pilot trial of transcutaneous low-frequency ultrasound, in combination with tissue-type plasminogen activator (t-PA), has shown feasibility and safety to treat patients with acute myocardial infarction (2).

The study by Miyamoto et al. (3) found that the coronary arteries as well as the coronary veins dilate in response to transthoracic low-frequency ultrasound. Transcutaneous low-frequency ultrasound augments ST-segment elevation resolution in dogs with coronary occlusion treated with t-PA (4). Suchkova et al. (5) found that ultrasound improves tissue perfusion in ischemic limbs, which is associated with capillary dilation. Pretreatment with an inhibitor of nitric oxide synthase blocked ultrasound enhancement of tissue perfusion and capillary dilation. These findings indicate that the effects of ultrasound are mediated through the nitric oxide. Based on this work, it is likely that ultrasound promotes mechanical shear on the endothelial cells and, thus, release of nitric oxide. This thesis is in agreement with that of Drs. Kipshidze.


   References
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 References
 

  1. Siegel RJ, Atar S, Fishbein MC, et al. Noninvasive, transthoracic, low-frequency ultrasound augments thrombolysis in a canine model of acute myocardial infarction. Circulation. 2000;101:2026–2029[Abstract/Free Full Text]
  2. Cohen MG, Tuero E, Bluguermann J, et al. Transcutaneous ultrasound facilitated coronary thrombolysis during acute myocardial infarction. Am J Cardiol. 2003;92:454–457[CrossRef][Medline]
  3. Miyamoto T, Neuman Y, Luo H, et al. Coronary vasodilation by noninvasive transcutaneous ultrasound. J Am Coll Cardiol. 2003;41:1623–1627[Abstract/Free Full Text]
  4. Birnbaum Y, Luo H, Atar S, et al. Noninvasive transthoracic low frequency ultrasound augments thrombolysis in a canine model of acute myocardial infarction—evaluation of the extent of ST-segment resolution. J Thromb Thrombolysis. 2001;11:229–234[Medline]
  5. Suchkova VN, Baggs RB, Sahni SK, Francis CW. Ultrasound improves tissue perfusion in ischemic tissue through a nitric oxide dependent mechanism. Thromb Haemost. 2002;88:865–870[Medline]



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