Influence of bone marrow stem cells on left ventricle perfusion and ejection fraction in patients with acute myocardial infarction of anterior wall: randomized clinical trial
Influence of bone marrow stem cells on left ventricle perfusion and ejection fraction in patients with acute myocardial infarction of anterior wall: randomized clinical trial
复制标题
DOI：
10.1093/eurheartj/ehp536
复制
发表时间：
2010-03-01
影响因子：
39.3
通讯作者：
Komarnicki, Mieczyslaw
中科院分区：
文献类型：
--
作者：
Grajek, Stefan;Popiel, Malgorzata;Komarnicki, Mieczyslaw
为评价急性前壁心肌梗死（AMI）患者经骨髓干细胞（BMSCs）治疗后左室射血分数（LVEF）和心肌灌注的变化，将45例患者按2：1随机分为BMSCs组（n= 31）和对照组（n = 14）。在直接PCI术后4-6天，将骨髓干细胞注入梗死相关动脉（伊拉）。各组均行99 m-MIBI心肌断层显像、核素心室造影（EF-RNV）、超声心动图（ECHO）和肺负荷试验。6个月后复查冠状动脉造影。EF-RNV在两组中没有显著差异，但在BMSC组中注意到6个月时EF增加并在12个月后维持的趋势。在静息研究中，6个月时BMSC组中由伊拉远端供血区域（PI-IRA）的灌注指数（PI）显著改善：4-6天时PI-IRA vs 6个月时PI-IRA（3.00 +/- 0.97 vs 2.65 +/- 0.64; P = 0.017）。12个月时，静息时PI-IRA为2.66 +/- 0.55; P = 0.07。在静息状态下，PI-IRA在BMSC和对照组之间没有观察到差异。在潘生丁研究中，6个月时，BMSC组的灌注优于对照组（2.26 ± 0.44 vs. 2.47 ± 0.40; P = 0.033）和12个月时（2.34 +/- 0.55 vs. 2.52 +/- 0.42; P = 0.014），也适用于伊拉供血区域（PI-IRA-dip; 6个月时2.63 +/- 0.77 vs. 3.06 +/- 0.46; P = 0.021; 12个月时2.71 +/- 0.63 vs. 3.15 +/- 0.51; P = 0.001）。ECHO的LVEF、LVEDV、LVESV和肺功能负荷试验结果在两组间无显著性差异。对照组主要心脏不良事件发生率明显高于对照组（P = 0.027）。在本研究中，前壁AMI患者冠状动脉内移植BMSC未导致EF增加。BMSC组心肌灌注略有改善。这一发现可能表明BMSCs可以改善微循环，但少数患者允许假设而不是最终声明。
Randomized trial to assess change in left ventricle ejection fraction (LVEF) and myocardial perfusion in patients with acute myocardial infarction (AMI) of anterior wall treated with bone marrow stem cells (BMSCs), compared with control group-from baseline in the acute phase up to 12 months of follow-up.Forty-five patients were randomized 2:1 to BMSC group (n= 31) or to control group (n = 14). Bone marrow stem cells were administered into infarct-related artery (IRA) at 4-6 day after primary PCI. Groups were followed up with Tc-99m-MIBI SPECT, radionuclide ventriculography (EF-RNV), echocardiography (ECHO), and spiroergometric stress test. Coronary angiography was repeated after 6 months. EF-RNV did not differ significantly in both groups, but trend towards increase in EF at 6 months and its maintenance after 12 months was noticed in the BMSC group. At rest study, perfusion index (PI) of region supplied with blood by IRA distal to its previous occlusion (PI-IRA) improved significantly in the BMSC group at 6 months: PI-IRA at 4-6 days vs. PI-IRA at 6 months (3.00 +/- 0.97 vs. 2.65 +/- 0.64; P = 0.017). At 12 months, PI-IRA at rest was 2.66 +/- 0.55; P = 0.07. The difference between BMSC and control groups at rest study in PI-IRA was not observed. At dipyridamole study (PI-dip), perfusion in the BMSC group was better compared with controls at 6 months (2.26 +/- 0.44 vs. 2.47 +/- 0.40; P = 0.033) and at 12 months (2.34 +/- 0.55 vs. 2.52 +/- 0.42; P = 0.014), also for region supplied with blood by IRA (PI-IRA-dip; at 6 months 2.63 +/- 0.77 vs. 3.06 +/- 0.46; P = 0.021 and at 12 months 2.71 +/- 0.63 vs. 3.15 +/- 0.51; P = 0.001). Results of LVEF, LVEDV, LVESV in ECHO and results of spiroergometric stress test did not differ significantly between groups. Major adverse cardiac events occurred more often in the control group (P = 0.027).In our study, BMSC intracoronary transplantation in patients with anterior AMI did not result in increase in EF. Slight improvement of myocardial perfusion was noticed in the BMSC group. This finding may indicate better microcirculation enhanced by BMSCs, but small number of patients allow for hypothesis rather than final statement.