Multiple imaging evaluation on the therapeutic efficacy of coronary artery bypass graft combined with autologous stem cell transplantation for myocardial infarction

doi:10.3969/j.issn.2095-4344.2017.33.014

Abstract

Abstract:

BACKGROUND: Stem cells are still controversial for the treatment of old myocardial infarction. Multimodal imaging evaluation is one of the key points in the study of stem cell transplantation, which can evaluate the therapeutic efficacy of stem cell transplantation from the perspective of molecular imaging.
OBJECTIVE: To evaluate the therapeutic efficacy of coronary artery bypass graft (CABG) with different stem cell transplantation in patients with old myocardial infarction using multimodal imaging technology.
METHODS: Sixty patients with old myocardial infarction were enrolled and randomly divided into three groups to receive CABG, CABG+autologous bone marrow stem cell transplantation (CABG+BMC) or CABG+autologous peripheral blood stem cell transplantation (CABG+PBSC), respectively. All the patients were scanned with gated PET/CT (¹³N-NH₃•H₂O/¹⁸F-FDG), echocardiography and coronary angiography at different time points orderly (at baseline, 1, 12 and 24 months after treatment). We compared the degree of coronary stenosis (%), left ventricular ejection fraction (LVEF), percentage of defect size with myocardial perfusion/metabolic abnormal radioactive distribution (A) and the ratio of defect area (R).
RESULTS AND CONCLUSION: In the diagnosis of survival myocardial segments, the sensitivity, specificity, positive predictive value and negative predictive value for the gated PET/CT were 92.1%, 85.6%, 93.4% and 78.4%, respectively. After the above treatments, the extent of coronary stenosis decreased significantly in the three groups (P < 0.05), which was improved most at 1 month after treatment (P < 0.05). In the CABG+BMC and CABG+PBSC groups, the LVEF value increased significantly after treatment (P < 0.05). In the CABG+BMC group, the A value decreased significantly at 1 and 24 months after treatment as compared with the baseline (P < 0.05), and the A value was further decreased, indicating a significant difference at 12 and 24 months after treatment (P < 0.05). In the CABG+BMC group, the R value significantly decreased at 1 month after treatment compared with the baseline (P=0.019). To conclude, the multimodal imaging is better to evaluate the prognosis of patients undergoing CABG with different stem cell transplantation, which is beneficial for the selection of treatment and therapeutic evaluation in myocardial infarction patients. CABG combined with stem cell transplantation can improve the left ventricular function of patients in a short time, and CABG+BMC is superior to CABG+PBSC to improve the survived myocardial function in patients.

中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

Key words: Myocardial Infarction, Myocardial Revascularization, Peripheral Blood Stem Cell Transplantation, Myeloid Progenitor Cells, Positron-Emission Tomography, Tissue Engineering

CLC Number:

R394.2

Lu Guo-xiu, Hao Shan-hu, Wang Zhi-guo, Zhang Tong, Wang Hui-shan, Zhang Guo-xu. Multiple imaging evaluation on the therapeutic efficacy of coronary artery bypass graft combined with autologous stem cell transplantation for myocardial infarction[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(33): 5332-5338.

Figures/Tables 2

2.1 参与者数量分析 60例患者在治疗后成功随访2年，无严重并发症发生，全部进入结果分析。 2.2 各组患者基本临床信息见表1。3组患者年龄、性别、心血管危险因素、受累冠脉比较差异无显著性意义(P > 0.05)，具有可比性。 2.3 研究对象入组流程图见图1。 2.4 冠脉血管造影及超声图像结果 60例患者术前检查发现30%存在冠状动脉中度狭窄(18/60)，70%为重度狭窄(42/60)；总计95支冠状动脉不同程度受累。针对相应病灶血管进行冠脉搭桥手术(平均1.58段/人)及联合干细胞移植治疗。3组患者治疗后血管狭窄程度均较治疗前改善(t=13.648，P < 0.05)，以治疗后1个月效果显著(F=15.436，P < 0.05)。3组间差异无显著性意义(F=1.356，P > 0.05)，见表2。通过心脏超声观察冠脉搭桥+骨髓干细胞移植组、冠脉搭桥+外周血干细胞移植组，治疗后12个月左心室射血分数升高(F=6.254，P=0.004)；而其他时间点，3组左心室射血分数治疗前、后变化差异无显著性意义，见表3。 2.5 门控PET/CT显像结果门控13N-NH•H2O/18F-FDG PET/CT诊断存活心肌的灵敏度、特异度、阳性预测值及阴性预测值分别为92.1%，85.6%，93.4%及78.4%。3组患者中，冠脉搭桥+骨髓干细胞移植组门控13N-NH3•H2O/ 18F-FDG PET/CT心肌血流灌注及代谢异常节段放射性分布评分A值，在治疗前、后不同时间点不同程度减低(F=3.749，P=0.014)。而其他两组门控13N-NH3•H2O/18F-FDG PET/CT心肌血流灌注及代谢异常节段放射性分布评分A值，在治疗前、后不同时间点差异无显著性意义(F=1.484，P=0.226，F=1.899，P=0.139)。冠脉搭桥+骨髓干细胞移植组，治疗前、后心肌13N-NH3•H2O血流灌注及18F-FDG代谢缺损面积比减低(F=2.919，P=0.039)，以治疗后1个月较治疗前减低明显(t=3.514，P=0.001)，而其他时间点之间差异均无显著性意义；其他两组治疗前、后心肌13N-NH3•H2O血流灌注及18F-FDG代谢缺损面积比减低差异均无显著性意义(F=1.484，P=0.226，F=1.899，P=0.139)，见表4，5。冠脉搭桥联合骨髓干细胞移植组中，治疗前后不同时间点，心肌门控13N-NH3•H2O/ PET/CT心肌血流灌注缺损面积比(R值)，差异有显著性意义(F=2.919，P=0.039)。而单独冠脉搭桥组及冠脉搭桥联合外周血干细胞移植治疗组中，治疗前后不同时间点，R值无明显差异(F=2.455，P=0.070；F=1.899，P=0.139)。冠脉搭桥联合骨髓干细胞移植组治疗1个月后心肌血流灌注缺损面积比，较治疗前下降(t=2.161，P=0.037)，而治疗后不同时间点间比较差异无显著性意义。 2.6 不良反应 60例患者在动员过程中发生骨痛4例，感觉乏力3例，心绞痛5例。"

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