Improvement of myocardial perfusion reserve detected by cardiovascular magnetic resonance after direct endomyocardial implantation of autologous bone marrow cells in patients with severe coronary artery disease.
BACKGROUND
Recent studies suggested that bone marrow (BM) cell implantation in patients with severe chronic coronary artery disease (CAD) resulted in modest improvement in symptoms and cardiac function. This study sought to investigate the functional changes that occur within the chronic human ischaemic myocardium after direct endomyocardial BM cells implantation by cardiovascular magnetic resonance (CMR).


RESULTS
We compared the interval changes of left ventricular ejection fraction (LVEF), myocardial perfusion reserve and the extent of myocardial scar by using late gadolinium enhancement CMR in 12 patients with severe CAD. CMR was performed at baseline and at 6 months after catheter-based direct endomyocardial autologous BM cell (n = 12) injection to viable ischaemic myocardium as guided by electromechanical mapping. In patients randomized to receive BM cell injection, there was significant decrease in percentage area of peri-infarct regions (-23.6%, P = 0.04) and increase in global LVEF (+9.0%, P = 0.02), the percentage of regional wall thickening (+13.1%, P= 0.04) and MPR (+0.25%, P = 0.03) over the target area at 6-months compared with baseline.


CONCLUSIONS
Direct endomyocardial implantation of autologous BM cells significantly improved global LVEF, regional wall thickening and myocardial perfusion reserve, and reduced percentage area of peri-infarct regions in patients with severe CAD.
Chan
Carmen Wing-Sze
CW
Cardiology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Kwong
Yok-Lam
YL
Kwong
Raymond Y
RY
Lau
Chu-Pak
CP
Tse
Hung-Fat
HF
D000368:Aged; D016026:Bone Marrow Transplantation; D002908:Chronic Disease; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007267:Injections; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
D003287:Contrast Media; D019786:Gadolinium DTPA