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.
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.
Gyöngyösi
Mariann
M
Division of Cardiology, Department of Internal Medicine II, University of Vienna, Wahringer Gürtel 18-20, A-1090 Vienna, Austria. mariann.gyongyosi@meduniwien.ac.at
Khorsand
Aliasghar
A
Zamini
Sholeh
S
Sperker
Wolfgang
W
Strehblow
Christoph
C
Kastrup
Jens
J
Jorgensen
Eric
E
Hesse
Birger
B
Tägil
Kristina
K
Bøtker
Hans Erik
HE
Ruzyllo
Witold
W
Teresiñska
Anna
A
Dudek
Dariusz
D
Hubalewska
Alicja
A
Rück
Andreas
A
Nielsen
Søren Steen
SS
Graf
Senta
S
Mundigler
Gerald
G
Novak
Jacek
J
Sochor
Heinz
H
Maurer
Gerald
G
Glogar
Dietmar
D
Sylven
Christer
C
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*
C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A