Kamínek Milan, Meluzín Jaroslav, Janousek Stanislav, Groch Ladislav, Panovský Roman, Klabusay Martin, Mayer Jirí, Prásek Jirí, Stanícek Jaroslav, Rehák Zdenek, Myslivecek Miroslav
Department of Nuclear Medicine, University Hospital, Olomouc, Czech Republic.
Nucl Med Rev Cent East Eur. 2006;9(1):60-4.
A lot of unresolved questions still exist concerning the exact mechanism of the beneficial effects of bone marrow cell (BMC) transplantation for myocardial regeneration. The aim of this communication is to report the cases of patients with and without post-transplantation left ventricular function improvement.
To this study we included consecutive patients with irreversible damage after a first acute ST-elevation myocardial infarction treated by coronary angioplasty with stent implantation. The irreversible damage was identified by dobutamine echocardiography and confirmed by rest gated Tc-99m-MIBI gated SPECT and in the majority of patients by F-18-FDG PET imaging as well. Using 4D-MSPECT software, we quantified MIBI/FDG uptake and gated SPECT left ventricular ejection fraction, end-diastolic/end-systolic volumes (LVEF, EDV/ESV) before BMC therapy and 3 months later.
The results obtained in the initial group of patients in this study (27 patients in the BMC treated group, 16 patients in the control group) have been published previously [Eur J Nucl Med 2005; 32 (Suppl 1 ): S46]. Among the BMC group, we identified 13 responders to therapy with average LVEF improvement from 43.3% +/- 11% to 51.4% +/- 10.4% and EDV/ESV improvement from 145 ml/84 ml to 133 ml/67 ml. The remaining 14 patients were non-responders to therapy with no significant change in LVEF (39.1% +/- 8.1% versus 39.8% +/- 7.4%), the EDV/ESV increased from 166 ml/105 ml to 188 ml/116 ml. Responders to the cell therapy had prevailing MIBI uptake in the range of 31-50% of maximum in the infarction territory. On the other hand, non-responders to BMC therapy had prevailing MIBI uptake in the range of 0-30% of maximum. Two cases are presented in this report.
Further studies with a larger cohort of patients would be helpful to evaluate our findings. We observed strong interindividual differences in the effectiveness of the cell therapy. Prevailing residual MIBI uptake in the range of 31-50% of maximum was in the subgroup of responders to the cell therapy.
关于骨髓细胞（BMC）移植促进心肌再生的有益作用的确切机制，仍存在许多未解决的问题。本报告旨在汇报移植后左心室功能改善和未改善的患者病例。
本研究纳入了因首次急性ST段抬高型心肌梗死接受冠状动脉血管成形术并植入支架后出现不可逆损伤的连续患者。通过多巴酚丁胺超声心动图确定不可逆损伤，并通过静息门控Tc-99m-MIBI门控单光子发射计算机断层扫描（SPECT）进行确认，大多数患者还通过F-18-氟代脱氧葡萄糖正电子发射断层扫描（PET）成像进行了确认。使用4D-MSPECT软件，我们在BMC治疗前和3个月后对MIBI/FDG摄取以及门控SPECT左心室射血分数、舒张末期/收缩末期容积（LVEF、EDV/ESV）进行了量化。
本研究初始患者组（BMC治疗组27例，对照组16例）的结果已在之前发表[《欧洲核医学杂志》2005年；32（增刊1）：S46]。在BMC组中，我们确定了13例治疗有反应者，其平均LVEF从43.3%±11%提高到51.4%±10.4%，EDV/ESV从145 ml/84 ml改善到133 ml/67 ml。其余14例患者为治疗无反应者，LVEF无显著变化（39.1%±8.1%对39.8%±7.4%），EDV/ESV从166 ml/105 ml增加到188 ml/116 ml。细胞治疗有反应者在梗死区域的MIBI摄取主要在最大值的31%-50%范围内。另一方面，BMC治疗无反应者的MIBI摄取主要在最大值的0%-30%范围内。本报告展示了两个病例。
对更多患者进行进一步研究将有助于评估我们的发现。我们观察到细胞治疗效果存在强烈的个体差异。细胞治疗有反应者亚组中，主要残留MIBI摄取在最大值的31%-50%范围内。
