Gastl M, Sürder D, Corti R, Faruque Osmany D M M, Gotschy A, von Spizcak J, Sokolska J, Metzen D, Alkadhi H, Ruschitzka F, Kozerke S, Manka R
Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland.; Department Cardiology, Pneumology and Angiology, Heinrich Heine University, Düsseldorf, Germany.
Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
Int J Cardiol. 2020 Jul 1;310:108-115. doi: 10.1016/j.ijcard.2020.01.025. Epub 2020 Jan 15.
Studies indicate no clear impact of intracoronary injection of bone-marrow unselected mononuclear cells (BM-MNC) after acute myocardial infarction (AMI) on left-ventricular function (LVEF). Strain parameters by cardiovascular magnetic resonance (CMR) have been proposed to be more sensitive to functional changes of the heart. The aim of the present study was to assess changes of global longitudinal (GLS) and circumferential strain (GCS) in a group of patients treated with BM-MNC after AMI.
One-hundred and forty-nine patients with successfully reperfused AMI and LV dysfunction (LVEF<45%) were retrospectively included into this sub-study of the SWISS-AMI multicentre trial. Patients were divided into control (N = 54), early (5-7 days after AMI, N = 51) and late BM-MNC treatment groups (3-4 weeks, N = 44). The endpoint was the change of GLS and GCS as obtained from cine sequences 4 and 12 months after AMI using feature tracking algorithm.
In unadjusted analyses, the absolute change of GLS for the early treatment group from baseline to 4 months was 2.5 ± 4.3 (p < 0.01), to 12 months 2.7 ± 5.7% (p = 0.004). For late treatment, it was 1.5 ± 4.0% (p = 0.039, 4 months) and 2.5 ± 5.6% (p = 0.015, 12 months). For controls 0.7 ± 4.7% (p = 0.378), 0.8 ± 3.9% (p = 0.253) respectively. Adjusting for different baseline values, neither an overall treatment effect (both time-points) of BM-MNC nor a treatment time-related (only early or late) effect could be shown for all functional parameters.
Among patients after AMI with successful reperfusion and LV dysfunction, intracoronary infusion of BM-MNC early or late after AMI did not improve global strain parameters at 4- or 12-months follow-up.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00355186.
研究表明，急性心肌梗死（AMI）后冠状动脉内注射未分选的骨髓单个核细胞（BM-MNC）对左心室功能（LVEF）无明显影响。心血管磁共振（CMR）的应变参数已被认为对心脏功能变化更敏感。本研究的目的是评估一组AMI后接受BM-MNC治疗的患者的整体纵向应变（GLS）和圆周应变（GCS）的变化。
149例成功再灌注的AMI和左心室功能障碍（LVEF<45%）患者被回顾性纳入SWISS-AMI多中心试验的这项子研究。患者分为对照组（N = 54）、早期治疗组（AMI后5 - 7天，N = 51）和晚期BM-MNC治疗组（3 - 4周，N = 44）。终点是使用特征跟踪算法在AMI后4个月和12个月从电影序列中获得的GLS和GCS的变化。
在未校正分析中，早期治疗组从基线到4个月GLS的绝对变化为2.5±4.3（p<0.01），到12个月为2.7±5.7%（p = 0.004）。晚期治疗组分别为1.5±4.0%（p = 0.039，4个月）和2.5±5.6%（p = 0.015，12个月）。对照组分别为0.7±4.7%（p = 0.378），0.8±3.9%（p = 0.253）。对不同基线值进行校正后，对于所有功能参数，既未显示BM-MNC的总体治疗效果（两个时间点），也未显示与治疗时间相关的（仅早期或晚期）效果。
在成功再灌注且存在左心室功能障碍的AMI患者中，AMI后早期或晚期冠状动脉内注入BM-MNC在4个月或12个月随访时未改善整体应变参数。
