Ito Yoshito, Kawamura Takuji, Chimura Misato, Miyagawa Shigeru
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita, Osaka 565-0871, Japan.
Department of Cardiology, Osaka University Graduate School of Medicine, 2-2-E1, Yamadaoka, Suita, Osaka 565-0871, Japan.
Eur Heart J Case Rep. 2023 Sep 21;7(10):ytad470. doi: 10.1093/ehjcr/ytad470. eCollection 2023 Oct.
Autologous myoblast patch (AMP) transplantation has resulted in good clinical outcomes for end-stage ischaemic cardiomyopathy, but the mechanisms behind them are unclear. Herein, we report the relationship between mitochondrial function and coronary flow reserve (CFR) before and after AMP transplantation.
The patient was a 73-year-old man who underwent coronary artery bypass grafting (CABG). At that time, the left ventricular ejection fraction (LVEF) was 53%, but it declined to 25% after 6 years. He was diagnosed with ischaemic cardiomyopathy (ICM). Coronary flow reserve in NH-positron emission tomography (NH-PET) was impaired to 1.69. In Tc-99m MIBI scintigraphy, the washout rate (WR) was 17%, suggestive of impaired mitochondrial function. He was not a candidate for heart transplantation, and we performed AMP transplantation 6 years after CABG. One year after AMP transplantation, LVEF, CFR, and Tc-99m MIBI WR improved to 36%, 2.07, and 7%, respectively. The Tc-99m MIBI WR improved especially in the anterolateral region, and the CFR increased in almost all segments.
In this case, AMP transplantation for ICM improved cardiac function, CFR, and mitochondrial function. The mitochondrial transfer from the transplanted myoblasts to the damaged myocardium may have contributed to the mitochondrial function improvement. This probably induced myocardial energy metabolism recovery and decreased oxygen demand. AMP transplantation also has the potential to improve microvascular dysfunction, due to angiogenesis induction. These effects can lead to improved prognoses of ICM after AMP transplantation, highlighting its potential to cure refractory heart failure.
自体成肌细胞片（AMP）移植已在终末期缺血性心肌病的治疗中取得了良好的临床效果，但其背后的机制尚不清楚。在此，我们报告了AMP移植前后线粒体功能与冠状动脉血流储备（CFR）之间的关系。
该患者为一名73岁男性，曾接受冠状动脉旁路移植术（CABG）。当时，左心室射血分数（LVEF）为53%，但6年后降至25%。他被诊断为缺血性心肌病（ICM）。NH-正电子发射断层扫描（NH-PET）中的冠状动脉血流储备受损至1.69。在锝-99m甲氧基异丁基异腈（Tc-99m MIBI）心肌显像中，洗脱率（WR）为17%，提示线粒体功能受损。他不符合心脏移植的条件，因此在CABG术后6年接受了AMP移植。AMP移植后一年，LVEF、CFR和Tc-99m MIBI WR分别改善至36%、2.07和7%。尤其是前外侧区域的Tc-99m MIBI WR有所改善，几乎所有节段的CFR均有所增加。
在本病例中，ICM的AMP移植改善了心脏功能、CFR和线粒体功能。移植的成肌细胞向受损心肌的线粒体转移可能有助于线粒体功能的改善。这可能诱导了心肌能量代谢的恢复并降低了氧需求。由于诱导血管生成，AMP移植还有改善微血管功能障碍的潜力。这些作用可导致ICM在AMP移植后的预后得到改善，突出了其治愈难治性心力衰竭的潜力。
