In those who suffer from atrial fibrillation, the risk to the brain rises. The “enemy” to be identified and contrasted is the blood clot, which can form due to disturbances in normal circulatory flows linked to the most widespread arrhythmia, frequent especially in old age. The lumps, in fact, can also move and go towards the vessels that supply the brain, causing a stroke. Discovering them in advance, however, is very difficult. To detect them, when the test is indicated, a probing examination is normally employed, thetransesophageal ultrasound, which involves the use of a probe inserted right into the first part of the digestive tract through the mouth and obviously requires sedation. Now, however, a first observation comes from the US on a few people that opens the way for future targeted and practically non-invasive monitoring for those at risk of forming these dangerous clots. Researchers from Massachusetts General Hospital developed it, publishing their work in the journal JACC – Cardiovascular Imaging.
The idea is to “color” the accumulations of fibrin with a special “marker”, a specific contrast agent which can then be identified with the PET. So in a non-invasive way. The study, coordinated by David Sosnovik who is also a lecturer at Harvard University, it’s simple. It involves the use of an agent developed to bind to fibrin, the “glue” that joins the clot mixture. Thanks to this “spy” in practice the lumps present in the body and not only in the heart, behave like light bulbs and light up, being easily identified in the circulatory stream. The specialist then, with an intravenous injection into a small vein, introduces the substance that binds to fibrin into the blood. This, if it does not find clots, is quickly eliminated. But if it binds to the clot it can be easily traced with positron emission tomography, precisely the Pet.
Currently, the researchers evaluated the safety of this approach in a few healthy volunteers, then administered it to people suffering from atrial fibrillation, in some cases with clots within the heart and in others not. And they saw that in the subjects without lumps nothing was seen, while light signals were turned on in correspondence with the clots. The “spy” therefore moves well in the blood and is extremely accurate.
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“The possibility of diagnosing the presence of clots in the left atrium without resorting to methods such as esophageal echocardiography would be of great help for patients with atrial fibrillation – he comments Giulio Molon, director of Cardiology at l’Irccs Sacred Heart of Negrar. Currently, patients undergo transesophageal ultrasound, with the need for sedation, staff commitment, time, some possible risk associated with the procedure. The idea behind this research would eliminate all this by making it much easier to search in stroke patients, to confirm the possible cardioembolic cause, Not only that: this technique would also be extremely helpful to exclude the presence of thrombus, which we do. regularly before heart surgery for arrhythmic diseases such as ablation and cardioversions, in order to proceed safely. The prospect is really interesting, considering that in the future this strategy could be used to search for thrombi in other pathologies such as pulmonary thromboembolism “.
Obviously, it will take some time to think about the routine use of this approach in the clinic. but the important thing is to have sown a seed in the frantic search for possible clots in the heart, and not only, related to atrial fibrillation. In fact, the appearance of cerebral ischemia can be linked to these lumps: the risk of a stroke in conditions of this type can rise up to five times, and for this specific preventive treatments are indicated.
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