自体骨髓单个核干细胞心肌内注射对局部心肌灌注的影响。NOGA 指导下的 MYSTAR 前瞻性随机研究的亚组分析。

Effect of intramyocardial delivery of autologous bone marrow mononuclear stem cells on the regional myocardial perfusion. NOGA-guided subanalysis of the MYSTAR prospective randomised study.

机构信息

Department of Cardiology, Medical University of Vienna, Vienna, Austria.

出版信息

Thromb Haemost. 2010 Mar;103(3):564-71. doi: 10.1160/TH09-08-0520. Epub 2010 Jan 13.

PMID:20076851

Abstract

The aim of the sub-study of the MYSTAR randomised trial was to analyse the changes in myocardial perfusion in NOGA-defined regions of interest (ROI) with intramyocardial injections of autologous bone marrow mononuclear cells (BM-MNC) using an elaborated transformation algorithm. Patients with recent first acute myocardial infarction (AMI) and left ventricular (LV) ejection fraction (EF) between 30-45% received BM-MNC by intramyocardial followed by intracoronary injection 68 +/- 34 days post-AMI (pooled data of MYSTAR). NOGA-guided endocardial mapping and 99m-Sestamibi-SPECT (single photon emission computer tomography) were performed at baseline and at three months follow-up (FUP). ROI was delineated as a best polygon by connecting of injection points of NOGA polar maps. ROIs were projected onto baseline and FUP polar maps of SPECT calculating the perfusion severity of ROI. Infarct size was decreased (from 27.2 +/- 10.7% to 24.1 +/- 11.5%, p<0.001), and global EF increased (from 38 +/- 6.1% to 41.5 +/- 8.4%, p<0.001) three months after BM-MNC delivery. Analysis of ROI resulted in a significant increase in unipolar voltage (index of myocardial viability) (from 7.9 +/- 3.0 mV to 9.9 +/- 2.7 mV at FUP, p<0.001) and local linear shortening (index of local wall motion disturbances) (from 11.0 +/- 3.9% to 12.7 +/- 3.4%, p=0.01). NOGA-guided analysis of the intramyocardially treated area revealed a significantly increased tracer uptake both at rest (from 56.7 +/- 16.1% to 62.9 +/- 14.2%, p=0.003) and at stress (from 59.3 +/- 14.2% to 62.3 +/- 14.9%, p=0.01). Patients exhibiting >or=5% improvement in perfusion defect severity received a significantly higher number of intramyocardial BM-MNC. In conclusion, combined cardiac BM-MNC delivery induces significant improvement in myocardial viability and perfusion in the intramyocardially injected area.

摘要

本研究旨在分析 MYSTAR 随机试验的亚组研究结果，使用改良的转换算法分析自体骨髓单个核细胞（BM-MNC）心肌内注射后诺加（NOGA）定义的感兴趣区（ROI）的心肌灌注变化。近期首次急性心肌梗死（AMI）且左心室射血分数（EF）在 30-45%的患者于 AMI 后 68 +/- 34 天行 BM-MNC 心肌内注射，然后冠状动脉内注射（MYSTAR 汇总数据）。基线和 3 个月随访（FU）时行 NOGA 心内膜映射和 99m-Sestamibi-SPECT（单光子发射计算机断层扫描）检查。ROI 通过连接 NOGA 极坐标图的注射点进行最佳多边形描绘。ROI 投射到 SPECT 的基线和 FU 极坐标图上，计算 ROI 的灌注严重程度。梗死面积减少（从 27.2 +/- 10.7%降至 24.1 +/- 11.5%，p<0.001），全球 EF 增加（从 38 +/- 6.1%增至 41.5 +/- 8.4%，p<0.001）。BM-MNC 输注后 3 个月，ROI 分析显示单极电压（心肌存活指数）显著增加（从 FU 时的 7.9 +/- 3.0 mV 增加至 9.9 +/- 2.7 mV，p<0.001），局部线性缩短（局部壁运动障碍指数）也显著增加（从 11.0 +/- 3.9%增加至 12.7 +/- 3.4%，p=0.01）。NOGA 指导的心肌内治疗区域分析显示，静息时（从 56.7 +/- 16.1%增加至 62.9 +/- 14.2%，p=0.003）和应激时（从 59.3 +/- 14.2%增加至 62.3 +/- 14.9%，p=0.01）示踪剂摄取均显著增加。灌注缺陷严重程度改善>或=5%的患者接受了更多的心肌内 BM-MNC。结论：心脏联合 BM-MNC 输注可显著改善心肌内注射区域的心肌存活和灌注。