经皮与手术递送自体成肌细胞治疗慢性心肌梗死：一项体内心血管磁共振研究。

Percutaneous versus surgical delivery of autologous myoblasts after chronic myocardial infarction: an in vivo cardiovascular magnetic resonance study.

机构信息

Multidisciplinary Department of Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec and Department of Medicine, Laval University, Québec, QC, Canada.

出版信息

Catheter Cardiovasc Interv. 2010 Jan 1;75(1):120-7. doi: 10.1002/ccd.22204.

DOI:10.1002/ccd.22204

PMID:19859959

Abstract

BACKGROUND

Stem cell transplantation for chronic myocardial infarction (MI) provides variable benefits. Most clinical trials have relied on surgical delivery, where results are biased by simultaneous coronary bypass. When bypass is not indicated, percutaneous delivery may provide comparable efficacy with reduced risk. We evaluated in vivo by cardiovascular magnetic resonance (CMR) the effects of autologous myoblast (AM) transplantation on myocardial morphology, function, perfusion and scar, and compared percutaneous versus surgical delivery.

METHODS

Chronic MI was completed in 10 Yucatan mini-pigs. Three months later, AM were injected in half by percutaneous NOGA(R) system and in the other half by surgical mini-thoracotomy. CMR was performed at baseline and 6 months after transplantation.

RESULTS

Six months after injection, AM transplantation led to a 26.3% decrease in indexed left ventricular end-diastolic volume (95% CI: 20.1-29.7%; P = 0.02), 25.5% thickening of the infarct-related segment (IRS) wall (95% CI: 19.6-33.2%; P = 0.03), and 20.9% increase in left ventricle (LV) ejection fraction (95% CI: 15.8-28.4%; P = 0.03). Scar tissue within IRS decreased by 29.4% (95% CI: 19.2-37.0%; P = 0.03), whereas the number of nonviable segments decreased by 25.0% (95% CI: 16.4-32.6%; P = 0.04). Myocardial perfusion of IRS improved by 29.1% (95% CI: 19.7-36.1%; P = 0.04). The arrhythmogenic peri-infarct zone increased by 33.2% (95% CI: 21.4-44.1%; P = 0.01) after AM transplantation. Benefits were similar by percutaneous or by surgical delivery.

CONCLUSIONS

Comprehensive in vivo CMR reveals reversed remodeling and improved systolic function, perfusion, and scar characteristics after AM transplantation. A relative increase in the arrhythmogenic peri-infarct border zone may explain previously reported arrhythmia. Percutaneous and surgical transplantation of AM both lead to comparable improvements in chronic MI.

摘要

背景

干细胞移植治疗慢性心肌梗死（MI）的效果存在差异。大多数临床试验依赖于外科手术递送，其结果会受到同时进行的冠状动脉旁路移植术的影响。当旁路移植术不适用时，经皮递送可能具有相似的疗效且风险更低。我们通过心血管磁共振（CMR）评估了自体成肌细胞（AM）移植对心肌形态、功能、灌注和瘢痕的影响，并比较了经皮与外科手术递送的效果。

方法

10 头尤卡坦小型猪完成慢性 MI 造模，3 个月后，通过经皮 NOGA（R）系统和外科小开胸术分别将 AM 注射到一半的心脏。移植后 6 个月进行 CMR 检查。

结果

移植后 6 个月，AM 移植导致左心室舒张末期容积指数降低 26.3%（95%置信区间：20.1%-29.7%；P = 0.02），梗死相关节段（IRS）壁增厚 25.5%（95%置信区间：19.6%-33.2%；P = 0.03），左心室射血分数增加 20.9%（95%置信区间：15.8%-28.4%；P = 0.03）。IRS 内的瘢痕组织减少 29.4%（95%置信区间：19.2%-37.0%；P = 0.03），而无活性节段的数量减少 25.0%（95%置信区间：16.4%-32.6%；P = 0.04）。IRS 的心肌灌注增加 29.1%（95%置信区间：19.7%-36.1%；P = 0.04）。AM 移植后，致心律失常性梗死周边区增加 33.2%（95%置信区间：21.4%-44.1%；P = 0.01）。经皮和外科递送 AM 均导致慢性 MI 相似的改善。