通过移植血管输送骨髓单个核细胞对既往心肌梗死和慢性心力衰竭患者的影响：一项关于左心室不同步的超声心动图研究

Effects of bone marrow mononuclear cells delivered through a graft vessel in patients with previous myocardial infarction and chronic heart failure: An echocardiographic study of left ventricular dyssynchrony.

作者信息

Qi Zhi, Liu Sheng, Duan Fujian

机构信息

The Department of Ultrasound, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.

The Department of Cardiovascular Surgery, Fuwai Hospital & Cardiovascular Institute, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Tsinghua University, Peking Union Medical College, Beijing, China.

出版信息

J Clin Ultrasound. 2018 Oct;46(8):512-518. doi: 10.1002/jcu.22609. Epub 2018 Aug 30.

DOI:10.1002/jcu.22609

PMID:30160313

Abstract

OBJECTIVES

Several trials are investigating the delivery of stem cells to treat ischemic cardiomyopathy. The aim of this study was the echocardiographic evaluation of the effectiveness of isolated coronary artery bypass graft (CABG) combined with bone marrow mononuclear cells (BMMNC) delivered through the graft vessels to improve left ventricular dyssynchrony in patients with previous myocardial infarction and chronic heart failure.

METHODS

42 patients with previous myocardial infarction and chronic heart failure were randomly allocated to either the CABG only group (n = 18) or the CABG with BMMNC graft group (n = 24group). We used 2D strain imaging to measure the absolute difference in time-to-peak radial strain between the earliest and the latest activated segments on LV short-axis images at the apical (RSTa), at the mitral annulus (RSTb), and at the papillary muscle (RSTm) level.

RESULTS

The effective rate of LV dyssynchrony improvement was significantly higher in the CABG + BMMNC than in the CABG only group (RSTb: 91.7% vs 50%, P < .05; RSTm: 78.6% vs 35.7%, P < .05; RSTa: 92.3% vs 50%, P < .05). The deterioration rate of LV synchrony was significantly lower in the CABG + BMMNC than in the CABG only group for RSTb (8.3% vs 70%, P < .05;) and RSTm (0 vs 50%, P < .05), but not for RSTa (18.2% vs 37.5%, P > .05).

CONCLUSIONS

Combining CABG with BMMNC delivering provided a better improvement of left ventricular dyssynchrony than CABG only.

摘要

目的

多项试验正在研究干细胞治疗缺血性心肌病的应用。本研究的目的是通过超声心动图评估单纯冠状动脉旁路移植术（CABG）联合经移植血管输送骨髓单个核细胞（BMMNC）改善既往心肌梗死和慢性心力衰竭患者左心室不同步的有效性。

方法

42例既往有心肌梗死和慢性心力衰竭的患者被随机分为单纯CABG组（n = 18）或CABG联合BMMNC移植组（n = 24组）。我们使用二维应变成像测量心尖（RSTa）、二尖瓣环（RSTb）和乳头肌（RSTm）水平左心室短轴图像上最早和最晚激活节段之间达到峰值径向应变的时间绝对差异。

结果

CABG联合BMMNC组左心室不同步改善的有效率显著高于单纯CABG组（RSTb：91.7%对50%，P <.05；RSTm：78.6%对35.7%，P <.05；RSTa：92.3%对50%，P <.05）。对于RSTb（8.3%对70%，P <.05）和RSTm（0对50%，P <.05），CABG联合BMMNC组左心室同步性恶化率显著低于单纯CABG组，但RSTa并非如此（18.2%对37.5%，P >.05）。