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.

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

doi:10.1186/1532-429x-12-6

Abstract

BackgroundRecent 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 ResultsWe 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.ConclusionsDirect 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.

Highlights

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
Recent clinical studies [1,2,3,4,5] suggest that direct implantation of autologous bone marrow (BM) cells into the ischaemic myocardium improves symptoms and exercise capacity and increases left ventricular (LV) function in patients with severe coronary artery disease (CAD)
cardiovascular magnetic resonance (CMR) Protocol Cine CMR CMR was performed at baseline and at 6 months after catheter-based direct endomyocardial autologous BM cell, and within one week after the single-photon emission computed tomography examination

Summary

Introduction

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). Recent clinical studies [1,2,3,4,5] suggest that direct implantation of autologous bone marrow (BM) cells into the ischaemic myocardium improves symptoms and exercise capacity and increases left ventricular (LV) function in patients with severe coronary artery disease (CAD). Despite the absence of trans-differentiation of transplanted BM cells into ischaemic myocardium, improvement in LV function is observed in experimental studies [6,7]. Emerging evidences from experimental studies indicate than BM cells might exert their benefit via paracrine effects to induce angiogenesis in

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Conclusion