Döbert Natascha, Britten Martina, Assmus Birgit, Berner Uwe, Menzel Christian, Lehmann Ralf, Hamscho Nadja, Schächinger Volker, Dimmeler Stefanie, Zeiher Andreas M, Grünwald Frank
Department of Nuclear Medicine, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Eur J Nucl Med Mol Imaging. 2004 Aug;31(8):1146-51. doi: 10.1007/s00259-004-1490-4. Epub 2004 Apr 3.
Clinical outcome after myocardial infarction depends on the extent of irreversibly damaged myocardium. Implantation of bone marrow-/circulating blood-derived progenitor cells has been shown to improve contractile cardiac function after myocardial infarction in both experimental and initial clinical studies. In the present study, first observations of the effect of local intracoronary progenitor cell infusion on the regeneration of infarcted cardiac tissue after acute myocardial infarction was evaluated by means of 18F-fluorodeoxyglucose positron emission tomography (PET) and 201Tl single-photon emission computed tomography (SPECT). Twenty-six patients underwent intracoronary infusion of bone marrow-derived (BMCs) (15 patients) or circulating blood-derived endothelial progenitor cells (EPCs) (11 patients) 4+/-2 days after acute myocardial infarction. Based on a left ventricular segmentation model (17 segments), mean signal intensities as a parameter of viability and perfusion in the infarct zone and non-infarct areas were calculated quantitatively by PET and SPECT at baseline and at 4 months of follow-up. Transplantation of progenitor cells was associated with a significant increase in the mean signal intensity (MSI) in the infarct zone from 54.5% (25th and 75th percentiles: 47.7%, 60.0%) to 58.0% (52.7%, 66.7%) on PET (P=0.013) and from 58.0% (49.5%, 63.0%) to 61.5% (52.5%, 70.2%) on SPECT (P=0.005). Global left ventricular ejection fraction (LVEF) increased from 53.5% (42.6%, 60.0%) to 58.0% (53.0%, 65.8%) (P<0.001). In the five patients without an increase in MSI on PET, LVEF changed from 60.0% (50.0%, 64.0%) to 72.0% (64.0%, 75.5%) at follow-up. PET and SPECT did not show any significant changes in MSI in the non-infarct areas [from 73% (68.5%, 76.2%) to 73% (69.7%, 78.0%) for PET and from 72.0% (66.5%, 77.6%) to 73.0% (67.5%, 78.2%) for SPECT]. There were no significant differences in myocardial viability and perfusion between BMC and EPC infusion. These preliminary results show that coronary stenting and transplantation of progenitor cells result in a significant increase in myocardial viability and perfusion. Therapeutic effects can be reliably measured by PET and SPECT.
心肌梗死后的临床结局取决于不可逆损伤心肌的范围。在实验研究和初步临床研究中均已表明，植入骨髓或循环血源性祖细胞可改善心肌梗死后的心脏收缩功能。在本研究中，通过18F-氟脱氧葡萄糖正电子发射断层扫描（PET）和201Tl单光子发射计算机断层扫描（SPECT）对急性心肌梗死后局部冠状动脉内注入祖细胞对梗死心脏组织再生的影响进行了首次观察。26例患者在急性心肌梗死后4±2天接受了冠状动脉内注入骨髓源性细胞（BMCs）（15例患者）或循环血源性内皮祖细胞（EPCs）（11例患者）。基于左心室分段模型（17个节段），在基线和随访4个月时通过PET和SPECT定量计算梗死区和非梗死区作为存活和灌注参数的平均信号强度。祖细胞移植与梗死区PET上的平均信号强度（MSI）从54.5%（第25和第75百分位数：47.7%，60.0%）显著增加至58.0%（52.7%，66.7%）（P = 0.013）以及SPECT上从58.0%（49.5%，63.0%）增加至61.5%（52.5%，70.2%）（P = 0.005）相关。整体左心室射血分数（LVEF）从53.5%（42.6%，60.0%）增加至58.0%（53.0%，65.8%）（P<0.001）。在PET上MSI未增加的5例患者中，随访时LVEF从60.0%（50.0%，64.0%）变为72.0%（64.0%，75.5%）。PET和SPECT未显示非梗死区MSI有任何显著变化[PET从73%（68.5%，76.2%）至73%（69.7%，78.0%），SPECT从72.0%（66.5%，77.6%）至73.0%（67.5%，78.2%）]。BMC和EPC注入之间在心肌存活和灌注方面无显著差异。这些初步结果表明，冠状动脉支架置入术和祖细胞移植可导致心肌存活和灌注显著增加。PET和SPECT可可靠地测量治疗效果。
