Nasseri Boris A, Kukucka Marian, Dandel Michael, Knosalla Christoph, Choi Yeong-Hoon, Ebell Wolfram, Hetzer Roland, Stamm Christof
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Cell Transplant. 2009;18(3):361-70. doi: 10.3727/096368909788534924.
The subtle effects of transplanted bone marrow cells (BMC) on regional myocardial behavior in patients with ischemic heart disease are difficult to assess. Novel echocardiographic techniques can quantify regional myocardial deformation (strain) and distinguish between passive and active wall motion. We hypothesized that this technique may help delineate cell therapy-induced changes in regional LV contractility that escape clinical routine studies. Twelve patients with coronary artery disease and impaired LV function (LVEF &<35%) underwent CABG surgery plus intramyocardial injection of autologous bone marrow mononuclear cells. Between two and five predefined segments of ischemic myocardium per patient received BMCs, and untreated ischemic segments served as internal controls. Segmental echocardiographic analysis of peak systolic strain by speckle tracking was performed before and 1 year after surgery and compared with standard wall motion analysis. Two patients died during the follow-up period. In the remaining 10 patients, mean LVEF increased from 24.5 +/- 10% to 32.1 +/- 11% (p = 0.02). A moderate improvement of systolic function was noted in ischemic control segments by both wall motion score (WMS) and 2D strain echocardiography (2DSE). In BMC-treated segments, WMS improved slightly, but the data failed to reach statistical significance. As assessed by 2DSE, however, systolic function of BMC-treated segments improved by nearly 100%. 2DSE proved to detect BMC-induced change with 30-fold higher sensitivity than WMS, and the Receiver Operating Characteristic curve (ROC) confirmed the diagnostic precision of 2DSE (area-under-the-ROC = 0.87). We conclude that echocardiographic speckle tracking two-dimensional strain analysis can detect cell therapy-induced changes in regional contractile function that may escape detection by standard wall motion assessment. Thus, 2DSE may be a useful tool for the further development of clinical cardiac cell therapy.
移植骨髓细胞（BMC）对缺血性心脏病患者局部心肌行为的细微影响难以评估。新型超声心动图技术可量化局部心肌变形（应变），并区分被动和主动壁运动。我们推测，该技术可能有助于描绘细胞治疗引起的局部左心室收缩力变化，而这些变化在临床常规研究中难以察觉。12例冠心病且左心室功能受损（左心室射血分数[LVEF]＜35%）的患者接受了冠状动脉旁路移植术（CABG）及心肌内注射自体骨髓单个核细胞。每位患者缺血心肌的2至5个预定义节段接受了BMC注射，未治疗的缺血节段作为内部对照。术前及术后1年采用斑点追踪法对收缩期峰值应变进行节段性超声心动图分析，并与标准壁运动分析进行比较。随访期间有2例患者死亡。在其余10例患者中，平均LVEF从24.5±10%增至32.1±11%（p = 0.02）。通过壁运动评分（WMS）和二维应变超声心动图（2DSE）均发现缺血对照节段的收缩功能有中度改善。在接受BMC治疗的节段中，WMS略有改善，但数据未达到统计学显著性。然而，通过2DSE评估，接受BMC治疗节段的收缩功能改善了近100%。2DSE检测BMC诱导变化的敏感性比WMS高约3０倍，受试者工作特征曲线（ROC）证实了2DSE的诊断准确性（ROC曲线下面积 = 0.87）。我们得出结论，超声心动图斑点追踪二维应变分析可检测到细胞治疗引起的局部收缩功能变化，而这些变化可能无法通过标准壁运动评估检测到。因此，2DSE可能是临床心脏细胞治疗进一步发展的有用工具。
