Episode 27 Cardiac Stem Cells This podcast features an interview by Bronwyn Cleary with Dr Magdelena Kostkiewicz at the EANM. The Role of Nuclear Imaging in Evaluating Myocardial Homing of Progenitor Cells and the Impact of Stem Cell Therapy on Myocardial Perfusion and Function.
BackgroundIn patients after myocardial infarction, stem cell therapy has already shown some clinical promise; however, many fundamental questions remain unanswered. The aim of this study was to evaluate the myocardial viability prior to stem cell transfer and its long-term effect on myocardial perfusion and function. In addition, early myocardial retention of tracer-labeled cells was evaluated.
Material and methods46 patients with a large anterior myocardial infarction (peak CK 2399-11213U/L, peak Tn I 68-249 ng/dL) were included in the study 6-9 days after primary PCI. The control group involved 12 patients not subjected to cell therapy (1:4 assignment). To evaluate myocardial perfusion and viability, regional and global left ventricular contractility, GSPECT was performed 2 days prior to autologous CD34+ cells’ transcoronary application. In addition, in a subgroup of 23 consecutive patients the cells were labeled with 99mTc-HMPAO to assess their early myocardial retention (i.e., homing to the infarct zone vs. border zone vs. non-infarcted area, myocardial SPECT) and proportion of retention in the heart vs. other organs (whole body SPECT). After 6 months, GSPECT was repeated.
Results. In the impaired segments, improvement in both perfusion and ejection (global, regional) fraction was observed at 6 months (45- 49 % in the active group, 52-54% in controls). One hour after transcoronary transfer, 4.72 (1.45-8.42)% activity was detected in the myocardium. In 87% patients there was a clear border-zone engraftment, without any detectable retention in the no-perfusion zone. There was a correlation between peak TnI (but not cell number) and early engraftment efficiency (r=0.54, p=0.052).
Conclusions ; Our preliminary results support the hypothesis that, in patients with a large myocardial infarction, transcoronary implantation of autologous CD34+ cells stem cells has an impact on myocadial perfusion and function at 6 months. However, preferential engraftment of the (viable) border zone indicates that the area of ‘irreversible’ injury (no-perfusion zone) may not be accessible to transcoronary-delivered cells.
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