Aim: Extension and severity of myocardial scar may condition short and long term efficacy of autologous stem cell treatment. Methods: Five male patients (mean age 56 A ± 3 yrs) with previous myocardial infarction, multivessel coronary artery disease underwent 10 to 23 intramyocardial 0,1 ml injections of autologous stem cell in scarred myocardium concomitant with off-pump coronary artery bypass grafting. After open heart surgery, stem area was mapped on a 3D heart model by a cardiologist and a cardiac surgeon and transferred to the 20-segment model used for scintigraphic analysis. Delivery area was chosen according to: 1) dominance of scar; 2) akinesis; 3) ungraftability of the tributary coronary artery. 99mTc Tetrofosmin Gated SPECT (370 MBq, 64 views in a 180 degrees orbit, double head gamma camera) was performed at rest before, 10 weeks and four years after treatment with the same camera and acquisition parameters. Severity of scar was quantified as number of standard deviations below matched normals according to QPS protocol (GE Health Care) in 20 segments. In the same segments regional wall thickening was quantified by QGS protocol (GE Health Care). Results: Ten weeks after the implantation, Gated SPECT showed an improved regional perfusion in stem area in 2 patients in whom the reduction of scar was 32% and 61%, respectively. One patient showed a further reduction of 10% after four years. 3 patients who did not improve regional perfusion both at short and long term follow-up showed a more extensive scar area and an impairment in regional wall motion before surgery. Conclusion: In patients with previous myocardial infarction and multivessel coronary artery disease undergoing stem cell treatment in ungraftable areas, reperfusion was higher in those segments with more viability and less akinesis. Results observed at 10 weeks were confirmed by Gated SPECT at long term follow-up. Gated SPECT appears to be an optimal tool to assess short- and long term effect of stem cell treatment on regional blood flow and function.
Gated-SPECT allows the short and long term semi-quantitative evaluation of stem cell implantation in patients with previous myocardial infarction and dominance of scar
E M Ferdeghini;P Marzullo
2007
Abstract
Aim: Extension and severity of myocardial scar may condition short and long term efficacy of autologous stem cell treatment. Methods: Five male patients (mean age 56 A ± 3 yrs) with previous myocardial infarction, multivessel coronary artery disease underwent 10 to 23 intramyocardial 0,1 ml injections of autologous stem cell in scarred myocardium concomitant with off-pump coronary artery bypass grafting. After open heart surgery, stem area was mapped on a 3D heart model by a cardiologist and a cardiac surgeon and transferred to the 20-segment model used for scintigraphic analysis. Delivery area was chosen according to: 1) dominance of scar; 2) akinesis; 3) ungraftability of the tributary coronary artery. 99mTc Tetrofosmin Gated SPECT (370 MBq, 64 views in a 180 degrees orbit, double head gamma camera) was performed at rest before, 10 weeks and four years after treatment with the same camera and acquisition parameters. Severity of scar was quantified as number of standard deviations below matched normals according to QPS protocol (GE Health Care) in 20 segments. In the same segments regional wall thickening was quantified by QGS protocol (GE Health Care). Results: Ten weeks after the implantation, Gated SPECT showed an improved regional perfusion in stem area in 2 patients in whom the reduction of scar was 32% and 61%, respectively. One patient showed a further reduction of 10% after four years. 3 patients who did not improve regional perfusion both at short and long term follow-up showed a more extensive scar area and an impairment in regional wall motion before surgery. Conclusion: In patients with previous myocardial infarction and multivessel coronary artery disease undergoing stem cell treatment in ungraftable areas, reperfusion was higher in those segments with more viability and less akinesis. Results observed at 10 weeks were confirmed by Gated SPECT at long term follow-up. Gated SPECT appears to be an optimal tool to assess short- and long term effect of stem cell treatment on regional blood flow and function.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
