微血管阻塞可识别出一组在ST段抬高型心肌梗死后能从干细胞治疗中获益的患者。
Microvascular obstruction identifies a subgroup of patients who benefit from stem cell therapy following ST-elevation myocardial infarction.
作者信息
Davidson Sarah J, Roncalli Jerome, Surder Daniel, Corti Roberto, Chugh Atul R, Yang Phillip C, Henry Timothy D, Stanberry Larissa, Lemarchand Patricia, Beregi Jeau-Paul, Traverse Jay H
机构信息
Duke University School of Medicine, Durham, NC.
Federation de Cardiologie, Departmentie, Institute CARDIOMET, University Hospital of Toulouse, Toulose, France.
出版信息
Am Heart J. 2023 May;259:79-86. doi: 10.1016/j.ahj.2023.02.004. Epub 2023 Feb 14.
BACKGROUND
Microvascular obstruction (MVO) is associated with greater infarct size, adverse left-ventricular (LV) remodeling and reduced ejection fraction following ST-elevation myocardial infarction (STEMI). We hypothesized that patients with MVO may constitute a subgroup of patients that would benefit from intracoronary stem cell delivery with bone marrow mononuclear cells (BMCs) given previous findings that BMCs tended to improve LV function only in patients with significant LV dysfunction.
METHODS AND RESULTS
We analyzed the cardiac MRIs of 356 patients (303 M, 53 F) with anterior STEMIs who received autologous BMCs or placebo / control as part of 4 randomized clinical trials that included the Cardiovascular Cell Therapy Research Network (CCTRN) TIME trial and its pilot, the multicenter French BONAMI trial and SWISS-AMI trials. A total of 327 patients had paired imaging data at 1 year. All patients received 100 to 150 million intracoronary autologous BMCs or placebo / control 3 to 7 days following primary PCI and stenting. LV function, volumes, infarct size and MVO were assessed prior to infusion of BMCs and 1 year later. Patients with MVO (n = 210) had reduced LVEF and much greater infarct size and LV volumes compared to patients without MVO (n = 146) (P < .01). At 12 months, patients with MVO who received BMCs had significantly greater recovery of LVEF compared to those patients with MVO who received placebo (absolute difference = 2.7%; P < .05). Similarly, left-ventricular end-diastolic (LVEDVI) and end-systolic volume indices (LVESVI) demonstrated significantly less adverse remodeling in patients with MVO who received BMCs compared to placebo. In contrast, no improvement in LVEF or LV volumes was observed in those patients without MVO who received BMCs compared to placebo.
CONCLUSIONS
The presence of MVO on cardiac MRI following STEMI identifies a subgroup of patients who benefit from intracoronary stem cell therapy.
背景
微血管阻塞（MVO）与ST段抬高型心肌梗死（STEMI）后更大的梗死面积、不良的左心室（LV）重构及射血分数降低相关。鉴于既往研究发现骨髓单个核细胞（BMC）往往仅能改善左心室功能显著受损患者的左心室功能，我们推测MVO患者可能是一组能从冠状动脉内注射BMC中获益的亚组患者。
方法与结果
我们分析了356例前壁STEMI患者（303例男性，53例女性）的心脏磁共振成像（MRI），这些患者作为4项随机临床试验（包括心血管细胞治疗研究网络（CCTRN）的TIME试验及其预试验、多中心法国BONAMI试验和SWISS-AMI试验）的一部分，接受了自体BMC或安慰剂/对照治疗。共有327例患者在1年时具有配对的影像学数据。所有患者在初次经皮冠状动脉介入治疗（PCI）和支架置入术后3至7天接受1亿至1.5亿个冠状动脉内自体BMC或安慰剂/对照治疗。在输注BMC前及1年后评估左心室功能、容积、梗死面积和MVO。与无MVO的患者（n = 146）相比，有MVO的患者（n = 210）左心室射血分数（LVEF）降低，梗死面积和左心室容积更大（P < .01）。在12个月时，接受BMC治疗的有MVO的患者与接受安慰剂治疗的有MVO的患者相比，LVEF的恢复明显更大（绝对差异 = 2.7%；P < .05）。同样，与安慰剂相比，接受BMC治疗的有MVO的患者左心室舒张末期容积指数（LVEDVI）和收缩末期容积指数（LVESVI）显示出明显更少的不良重构。相比之下，与安慰剂相比，接受BMC治疗的无MVO的患者未观察到LVEF或左心室容积的改善。
结论
STEMI后心脏MRI显示存在MVO可识别出一组能从冠状动脉内干细胞治疗中获益的患者亚组。
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