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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2010 | Research

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

Authors: Carmen Wing-Sze Chan, Yok-Lam Kwong, Raymond Y Kwong, Chu-Pak Lau, Hung-Fat Tse

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2010

Abstract

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).

Methods and 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.

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Tse HF, Kwong YL, Chan JK, Lo G, Ho CL, Lau CP: Angiogenesis in ischaemic myocardium by intramyocardial autologous bone marrow mononuclear cell implantation. Lancet. 2003, 361: 47-49. 10.1016/S0140-6736(03)12111-3.CrossRefPubMed

Perin EC, Dohmann HF, Borojevic R, Silva SA, Sousa AL, Mesquita CT, Rossi MI, Carvalho AC, Dutra HS, Dohmann HJ, Silva GV, Belem L, Vivacqua R, Rangel FO, Esporcatte R, Geng YJ, Vaughn WK, Assad JA, Mesquita ET, Willerson JT: Transendocardial, autologous bone marrow cell transplantation for severe, chronic ischemic heart failure. Circulation. 2003, 107: 2294-2302. 10.1161/01.CIR.0000070596.30552.8B.CrossRefPubMed

Fuchs S, Satler LF, Kornowski R, Okubagzi P, Weisz G, Baffour R, Waksman R, Weissman NJ, Cerqueira M, Leon MB, Epstein SE: Catheter-based autologous bone marrow myocardial injection in no-option patients with advanced coronary artery disease. A feasibility study. J Am Coll Cardiol. 2003, 41: 1721-1724. 10.1016/S0735-1097(03)00328-0.CrossRefPubMed

Briguori C, Reimers B, Sarais C, Napodano M, Pascotto P, Azzarello G, Bregni M, Porcellini A, Vinante O, Zanco P, Peschle C, Condorelli G, Colombo A: Direct intramyocardial percutaneous delivery of autologous bone marrow in patients with refractory myocardial angina. Am Heart J. 2006, 151: 674-80. 10.1016/j.ahj.2005.04.033.CrossRefPubMed

Beeres SL, Bax JJ, Kaandorp TA, Zeppenfeld K, Lamb HJ, Dibbets-Schneider P, Stokkel MP, Fibbe WE, de Roos A, Wall van der EE, Schalij MJ, Atsma DE: Usefulness of intramyocardial injection of autologous bone marrow-derived mononuclear cells in patients with severe angina pectoris and stress-induced myocardial ischemia. Am J Cardiol. 2006, 97: 1326-31. 10.1016/j.amjcard.2005.11.068.CrossRefPubMed

Balsam LB, Wagers AJ, Christensen JL, Kofidis T, Weissman IL, Robbins RC: Haematopoietic stem cells adopt mature haematopoietic fates in ischaemic myocardium. Nature. 2004, 428: 668-673. 10.1038/nature02460.CrossRefPubMed

Chien KR: Stem cells: lost in translation. Nature. 2004, 428: 607-8. 10.1038/nature02500.CrossRefPubMed

Kinnaird T, Stabile E, Burnett MS, Shou M, Lee CW, Barr S, Fuchs S, Epstein SE: Local delivery of marrow-derived stromal cells augments collateral perfusion through paracrine mechanisms. Circulation. 2004, 109: 1543-1549. 10.1161/01.CIR.0000124062.31102.57.CrossRefPubMed

Tse HF, Siu CW, Zhu SG, Songyan L, Zhang QY, Lai WH, Kwong YL, Nicholls J, Lau CP: Paracrine effects of direct intramyocardial implantation of bone marrow derived cells for enhancement of neovascularization in chronic ischemic myocardium. Eur J Heart Fail. 2007, 9: 747-753. 10.1016/j.ejheart.2007.03.008.CrossRefPubMed

10.

Kim RJ, Fieno DS, Parrish TB, Harris K, Chen EL, Simonetti O, Bundy J, Finn JP, Klocke FJ, Judd RM: Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation. 1999, 100: 1992-2002.CrossRefPubMed

11.

Panting JR, Gatehouse PD, Yang GZ, Jerosch-Herold M, Wilke N, Firmin DN, Pennell DJ: Echo-planar magnetic resonance myocardial perfusion imaging: parametric map analysis and comparison with thallium SPECT. J Magn Reson Imaging. 2001, 13: 192-200. 10.1002/1522-2586(200102)13:2<192::AID-JMRI1029>3.0.CO;2-N.CrossRefPubMed

12.

Al-Saadi N, Nagel E, Gross M, Bornstedt A, Schnackenburg B, Klein C, Klimek W, Oswald H, Fleck E: Noninvasive detection of myocardial ischemia from perfusion reserve based on cardiovascular magnetic resonance. Circulation. 2000, 101: 1379-83.CrossRefPubMed

13.

Friedrich MG, Bluemke DA, Biederman RW, Martin ET, Lansky AJ, Kashanian F, Foo TK, Licato PE, Comeau CR: Myocardial firstpass perfusion magnetic resonance imaging: a multicenter dose-ranging study. Circulation. 2004, 110: 732-737. 10.1161/01.CIR.0000138106.84335.62.CrossRefPubMed

14.

Yan AT, Shayne AJ, Brown KA, Gupta SN, Chan CW, Luu TM, Di Carli MF, Reynolds HG, Stevenson WG, Kwong RY: Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation. 2006, 114: 34-39. 10.1161/CIRCULATIONAHA.106.613414.CrossRef

15.

Tse HF, Thambar S, Kwong YL, Rowlings P, Bellamy G, McCrohon J, Thomas P, Bastian B, Chan JK, Lo G, Ho CL, Chan WS, Kwong RY, Parker A, Hauser TH, Chan J, Fong DY, Lau CP: Prospective randomized trial of direct endomyocardial implantation of bone marrow cells for therapeutic angiogenesis in severe coronary artery diseases. Eur Heart J. 2007, 28: 2998-3005. 10.1093/eurheartj/ehm485.CrossRefPubMed

16.

Kwong RY, Chan AK, Brown KA, Chan CW, Reynolds GH, Tsang S, Davis RB: Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation. 2006, 113: 2733-2743. 10.1161/CIRCULATIONAHA.105.570648.CrossRefPubMed

17.

Simonetti OP, Kim RJ, Fieno DS, Hillenbrand HB, Wu E, Bundy JM, Finn JP, Judd RM: An improved MR imaging technique for the visualization of myocardial infarction. Radiology. 2001, 218: 215-223.CrossRefPubMed

18.

Alfakih K, Reid S, Jones T, Sivananthan M: Assessment of ventricular function and mass by cardiac magnetic resonance imaging. Eur Radiol. 2004, 14: 1813-1822. 10.1007/s00330-004-2387-0.CrossRefPubMed

19.

Cerqueria MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS: Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the cardiac imaging committee of the council on clinically cardiology of the American Heart Association. Circulation. 2002, 105: 539-542. 10.1161/hc0402.102975.CrossRef

20.

Wilke N, Jerosch-Herold M, Wang Y: Myocardial perfusion reserve: assessment with multisection, quantitative, first-pass MR imaging. Radiology. 1997, 204: 373-84.CrossRefPubMed

21.

Muhling OM, Wang Y, Panse P, Jerosch-Herold M, Cayton MM, Wann LS, Mirhoseini MM, Wilke NM: Transmyocardial laser revascularization preserves regional myocardial perfusion: an MRI first pass perfusion study. Cardiovasc Res. 2003, 57: 63-70. 10.1016/S0008-6363(02)00647-8.CrossRefPubMed

22.

Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM: The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000, 343: 1445-1453. 10.1056/NEJM200011163432003.CrossRefPubMed

23.

Mahrholdt H, Wagner A, Holly TA, Elliott MD, Bonow RO, Kim RJ, Judd RM: Reproducibility of chronic infarct size measurement by contrast-enhanced magnetic resonance imaging. Circulation. 2002, 106: 2322-2327. 10.1161/01.CIR.0000036368.63317.1C.CrossRefPubMed

24.

Murry CE, Soonpaa MH, Reinecke H, Nakajima H, Nakajima HO, Rubart M, Pasumarthi KB, Virag JI, Bartelmez SH, Poppa V, Bradford G, Dowell JD, Williams DA, Field LJ: Haematopoietic stem cells do not transdifferentiate into cardiac myocytes in myocardial infarcts. Nature. 2004, 428: 664-668. 10.1038/nature02446.CrossRefPubMed

25.

Kamihata H, Matsubara H, Nishiue T, Fujiyama S, Amano K, Iba O, Imada T, Iwasaka T: Improvement of collateral perfusion and regional function by implantation of peripheral blood mononuclear cells into ischemic hibernating myocardium. Arterioscler Thromb Vasc Biol. 2002, 22: 1804-10. 10.1161/01.ATV.0000039168.95670.B9.CrossRefPubMed

26.

Kinnaird T, Stabile E, Burnett MS, Epstein SE: Bone-marrow-derived cells for enhancing collateral development: mechanisms, animal data, and initial clinical experiences. Circ Res. 2004, 95: 354-63. 10.1161/01.RES.0000137878.26174.66.CrossRefPubMed

Title: 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
Authors: Carmen Wing-Sze Chan
Yok-Lam Kwong
Raymond Y Kwong
Chu-Pak Lau
Hung-Fat Tse
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2010
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/1532-429X-12-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods and Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods and Results

Conclusions

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