Gyöngyösi Mariann, Khorsand Aliasghar, Zamini Sholeh, Sperker Wolfgang, Strehblow Christoph, Kastrup Jens, Jorgensen Eric, Hesse Birger, Tägil Kristina, Bøtker Hans Erik, Ruzyllo Witold, Teresiñska Anna, Dudek Dariusz, Hubalewska Alicja, Rück Andreas, Nielsen Søren Steen, Graf Senta, Mundigler Gerald, Novak Jacek, Sochor Heinz, Maurer Gerald, Glogar Dietmar, Sylven Christer
Division of Cardiology, Department of Internal Medicine II, University of Vienna, Wahringer Gürtel 18-20, A-1090 Vienna, Austria.
Circulation. 2005 Aug 30;112(9 Suppl):I157-65. doi: 10.1161/01.CIRCULATIONAHA.105.525782.
The aim of this substudy of the EUROINJECT-ONE double-blind randomized trial was to analyze changes in myocardial perfusion in NOGA-defined regions with intramyocardial injections of plasmid encoding plasmid human (ph)VEGF-A(165) using an elaborated transformation algorithm.
After randomization, 80 no-option patients received either active, phVEGF-A165 (n=40), or placebo plasmid (n=40) percutaneously via NOGA-Myostar injections. The injected area (region of interest, ROI) was delineated as a best polygon by connecting of the injection points marked on NOGA polar maps. The ROI was projected onto the baseline and follow-up rest and stress polar maps of the 99m-Tc-sestamibi/tetrofosmin single-photon emission computed tomography scintigraphy calculating the extent and severity (expressed as the mean normalized tracer uptake) of the ROI automatically. The extents of the ROI were similar in the VEGF and placebo groups (19.4+/-4.2% versus 21.5+/-5.4% of entire myocardium). No differences were found between VEGF and placebo groups at baseline with regard to the perfusion defect severity (rest: 69+/-11.7% versus 68.7+/-13.3%; stress: 63+/-13.3% versus 62.6+/-13.6%; and reversibility: 6.0+/-7.7% versus 6.7+/-9.0%). At follow-up, a trend toward improvement in perfusion defect severity at stress was observed in VEGF group as compared with placebo (68.5+/-11.9% versus 62.5+/-13.5%, P=0.072) without reaching normal values. The reversibility of the ROI decreased significantly at follow-up in VEGF group as compared with the placebo group (1.2+/-9.0% versus 7.1+/-9.0%, P=0.016). Twenty-one patients in VEGF and 8 patients in placebo group (P<0.01) exhibited an improvement in tracer uptake during stress, defined as a >or =5% increase in the normalized tracer uptake of the ROI.
Projection of the NOGA-guided injection area onto the single-photon emission computed tomography polar maps permits quantitative evaluation of myocardial perfusion in regions treated with angiogenic substances. Injections of phVEGF A165 plasmid improve, but do not normalize, the stress-induced perfusion abnormalities.
本项欧洲注射-1双盲随机试验的子研究旨在使用精细的转换算法，分析心肌内注射编码人（ph）VEGF-A(165)质粒的情况下，NOGA定义区域中心肌灌注的变化。
随机分组后，80例无其他治疗选择的患者通过NOGA-Myostar注射法经皮接受活性phVEGF-A165（n = 40）或安慰剂质粒（n = 40）。通过连接NOGA极坐标图上标记的注射点，将注射区域（感兴趣区域，ROI）描绘为最佳多边形。将ROI投影到99m-Tc-司他米比/替曲膦单光子发射计算机断层扫描闪烁成像的基线及随访静息和负荷极坐标图上，自动计算ROI的范围和严重程度（以平均标准化示踪剂摄取表示）。VEGF组和安慰剂组的ROI范围相似（分别占整个心肌的19.4±4.2%和21.5±5.4%）。VEGF组和安慰剂组在基线时灌注缺损严重程度方面无差异（静息：69±11.7%对68.7±13.3%；负荷：63±13.3%对62.6±13.6%；以及可逆性：6.0±7.7%对6.7±9.0%）。随访时，与安慰剂组相比，VEGF组在负荷时灌注缺损严重程度有改善趋势（68.5±11.9%对62.5±13.5%，P = 0.072），但未达到正常水平。与安慰剂组相比，VEGF组ROI的可逆性在随访时显著降低（1.2±9.0%对7.1±9.0%，P = 0.016）。VEGF组21例患者和安慰剂组8例患者（P<0.01）在负荷时示踪剂摄取有改善，定义为ROI标准化示踪剂摄取增加≥5%。
将NOGA引导的注射区域投影到单光子发射计算机断层扫描极坐标图上，可对血管生成物质治疗区域的心肌灌注进行定量评估。注射phVEGF A165质粒可改善负荷诱导的灌注异常，但不能使其恢复正常。
