title: NOGA-guided analysis of regional myocardial perfusion abnormalities treated with intramyocardial injections of plasmid encoding vascular endothelial growth factor A-165 in patients with chronic myocardial ischemia: subanalysis of the EUROINJECT-ONE multicenter double-blind randomized study.
abstract: BACKGROUND
  The aim of this substudy of the EUROINJECT-ONE double-blind randomized trial was to analyze changes in myocardial perfusion in NOGA-defined regions with intramyocardial injections of plasmid encoding plasmid human (ph)VEGF-A(165) using an elaborated transformation algorithm.
  
  
  RESULTS
  After randomization, 80 no-option patients received either active, phVEGF-A165 (n=40), or placebo plasmid (n=40) percutaneously via NOGA-Myostar injections. The injected area (region of interest, ROI) was delineated as a best polygon by connecting of the injection points marked on NOGA polar maps. The ROI was projected onto the baseline and follow-up rest and stress polar maps of the 99m-Tc-sestamibi/tetrofosmin single-photon emission computed tomography scintigraphy calculating the extent and severity (expressed as the mean normalized tracer uptake) of the ROI automatically. The extents of the ROI were similar in the VEGF and placebo groups (19.4+/-4.2% versus 21.5+/-5.4% of entire myocardium). No differences were found between VEGF and placebo groups at baseline with regard to the perfusion defect severity (rest: 69+/-11.7% versus 68.7+/-13.3%; stress: 63+/-13.3% versus 62.6+/-13.6%; and reversibility: 6.0+/-7.7% versus 6.7+/-9.0%). At follow-up, a trend toward improvement in perfusion defect severity at stress was observed in VEGF group as compared with placebo (68.5+/-11.9% versus 62.5+/-13.5%, P=0.072) without reaching normal values. The reversibility of the ROI decreased significantly at follow-up in VEGF group as compared with the placebo group (1.2+/-9.0% versus 7.1+/-9.0%, P=0.016). Twenty-one patients in VEGF and 8 patients in placebo group (P<0.01) exhibited an improvement in tracer uptake during stress, defined as a >or =5% increase in the normalized tracer uptake of the ROI.
  
  
  CONCLUSIONS
  Projection of the NOGA-guided injection area onto the single-photon emission computed tomography polar maps permits quantitative evaluation of myocardial perfusion in regions treated with angiogenic substances. Injections of phVEGF A165 plasmid improve, but do not normalize, the stress-induced perfusion abnormalities.
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, University of Vienna, Wahringer Gürtel 18-20, A-1090 Vienna, Austria. mariann.gyongyosi@meduniwien.ac.at
authors.forename: Mariann
authors.initials: M
authors.lastname: Gyöngyösi
authors.forename: Aliasghar
authors.initials: A
authors.lastname: Khorsand
authors.forename: Sholeh
authors.initials: S
authors.lastname: Zamini
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sperker
authors.forename: Christoph
authors.initials: C
authors.lastname: Strehblow
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
authors.forename: Eric
authors.initials: E
authors.lastname: Jorgensen
authors.forename: Birger
authors.initials: B
authors.lastname: Hesse
authors.forename: Kristina
authors.initials: K
authors.lastname: Tägil
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
authors.forename: Anna
authors.initials: A
authors.lastname: Teresiñska
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Alicja
authors.initials: A
authors.lastname: Hubalewska
authors.forename: Andreas
authors.initials: A
authors.lastname: Rück
authors.forename: Søren Steen
authors.initials: SS
authors.lastname: Nielsen
authors.forename: Senta
authors.initials: S
authors.lastname: Graf
authors.forename: Gerald
authors.initials: G
authors.lastname: Mundigler
authors.forename: Jacek
authors.initials: J
authors.lastname: Novak
authors.forename: Heinz
authors.initials: H
authors.lastname: Sochor
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Dietmar
authors.initials: D
authors.lastname: Glogar
authors.forename: Christer
authors.initials: C
authors.lastname: Sylven
mesh_terms: D000465:Algorithms; D000787:Angina Pectoris / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization; D003326:Coronary Circulation; D004562:Electrocardiography; D005060:Europe; D005500:Follow-Up Studies; D015316:Genetic Therapy; D005822:Genetic Vectors / Q000008:administration & dosage; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D007273:Injections, Intramuscular; D008280:Magnetics; D017202:Myocardial Ischemia / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium; D012984:Software; D015899:Tomography, Emission-Computed, Single-Photon; D042461:Vascular Endothelial Growth Factor A / Q000235:genetics / Q000502:physiology*
chemical_list: C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A