Lu Minjie, Liu Sheng, Zheng Zhe, Yin Gang, Song Lei, Chen Huaibing, Chen Xiuyu, Chen Qiyin, Jiang Shiliang, Tian Liangxin, He Zuoxiang, Hu Shengshou, Zhao Shihua
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.
Int J Cardiol. 2013 Oct 3;168(3):2221-7. doi: 10.1016/j.ijcard.2013.01.217. Epub 2013 Mar 7.
Our preliminary study suggested that patients with chronic myocardial infarction (MI) and heart failure could potentially benefit from CABG combined with aBM-MNC by improving global left ventricular (LV) function. The purpose of this sub-study was to quantitatively evaluate the effectiveness of aBM-MNC transplantation during CABG in patients with chronic MI by intensively analyzing the global and segmental LV function, the scar, and the relationships between the function recovery and the scar transmural extent.
A randomized, double-blinded, placebo-controlled study was performed in 50 patients with chronic MI. The patients were randomly allocated into CABG with stem cell transplantation (group A) and CABG only (group B) groups. CMR assessments of global and segmental left ventricular function and scar tissue were performed before surgery and repeated at 12 months after CABG and aBM-MNC transplantation.
The left ventricular ejection fraction (LVEF) improved by 13.5% and 8.0% in group A and B respectively (P=0.04). Segmental analysis of regional LV function recovery indicated that more improvement in contractility was found in group A within the same degree of the infarct transmurality (P=0.017) and showed a predominant interaction in the most severely affected segments (76-100%, P=0.016). Decrease in infarct size between the two groups did not reach statistical difference (9.4% vs. 6.0%, P=0.100).
CMR assessments revealed reversed ventricular remodeling and improved systolic function and scar reduction in patients who underwent aBM-MNC transplantation during CABG. And the conjunctional use of CABG and stem cell therapy could improve the left ventricular function in patients with chronic MI.
我们的初步研究表明，慢性心肌梗死（MI）合并心力衰竭的患者可能通过冠状动脉旁路移植术（CABG）联合自体骨髓单个核细胞（aBM-MNC）改善左心室（LV）整体功能而获益。本亚组研究的目的是通过深入分析左心室整体和节段性功能、瘢痕以及功能恢复与瘢痕透壁程度之间的关系，定量评估CABG期间aBM-MNC移植对慢性MI患者的有效性。
对50例慢性MI患者进行了一项随机、双盲、安慰剂对照研究。患者被随机分为接受干细胞移植的CABG组（A组）和单纯CABG组（B组）。在手术前进行心脏磁共振成像（CMR）评估左心室整体和节段性功能以及瘢痕组织，并在CABG和aBM-MNC移植后12个月重复评估。
A组和B组的左心室射血分数（LVEF）分别提高了13.5%和8.0%（P = 0.04）。区域左心室功能恢复的节段分析表明，在相同梗死透壁程度下，A组的收缩性改善更为明显（P = 0.017），并且在受影响最严重的节段（76 - 100%）显示出显著的相互作用（P = 0.016）。两组梗死面积的减小未达到统计学差异（9.4%对6.0%，P = 0.100）。
CMR评估显示，在CABG期间接受aBM-MNC移植的患者出现了心室重构逆转、收缩功能改善和瘢痕减少。CABG与干细胞治疗联合应用可改善慢性MI患者的左心室功能。
