Summary
The aim of the sub-study of the MYSTAR randomised trial was to analyse the changes
in myocardial perfusion in NOGA-defined regions of interest (ROI) with intramyocardial
injections of autologous bone marrow mononuclear cells (BM-MNC) using an elaborated
transformation algorithm. Patients with recent first acute myocardial infarction (AMI)
and left ventricular (LV) ejection fraction (EF) between 30–45% received BM-MNC by
intramyocardial followed by intracoronary injection 68 ± 34 days post-AMI (pooled
data of MYSTAR). NOGA-guided endocardial mapping and 99m-Sestamibi-SPECT (single photon emission computer tomography) were performed at baseline
and at three months follow-up (FUP). ROI was delineated as a best polygon by connecting
of injection points of NOGA polar maps. ROIs were projected onto baseline and FUP
polar maps of SPECT calculating the perfusion severity of ROI. Infarct size was decreased
(from 27.2 ± 10.7% to 24.1 ± 11.5%, p<0.001), and global EF increased (from 38 ± 6.1%
to 41.5 ± 8.4%, p<0.001) three months after BM-MNC delivery. Analysis of ROI resulted
in a significant increase in unipolar voltage (index of myocardial viability) (from
7.9 ± 3.0 mV to 9.9 ± 2.7 mV at FUP, p<0.001) and local linear shortening (index of
local wall motion disturbances) (from 11.0 ± 3.9% to 12.7 ± 3.4%, p=0.01). NOGA-guided
analysis of the intramyocardially treated area revealed a significantly increased
tracer up-take both at rest (from 56.7 ± 16.1% to 62.9 ± 14.2%, p=0.003) and at stress
(from 59.3 ± 14.2% to 62.3 ± 14.9%, p=0.01). Patients exhibiting ≥5% improvement in
perfusion defect severity received a significantly higher number of intramyocardial
BM-MNC. In conclusion, combined cardiac BM-MNC delivery induces significant improvement
in myocardial viability and perfusion in the intramyocardially injected area.
Clinical Trials Gov Nr: NCT00384982.
Keywords
Acute myocardial infarction - stem cells, imaging
