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| Intracoronary infusion of mobilized peripheral blood stem cells by granulocyte colony-stimulating factor on myocardial perfusion and viability: Improvement of myocardial perfusion as plausible mechanism of stem cell therapy. |
| 서울대학교병원 순환기내과¹ , 서울대학교 의과대학 내과학교실² |
| 이해영¹, 강현재¹ , 구본권¹ ² , 장성아¹ , 박경우¹ , 김효수¹ ² , 오병희¹ ² , 박영배¹ ² , 최윤식¹ ² |
Background: Previously we reported six month follow-up result of “Myocardial Regeneration and Angiogenesis in Myocardial Infarction with G-CSF and Intra-Coronary Stem Cell Infusion-3-DES (MAGIC cell–3-DES)” trial showing that intracoronary infusion of mobilized PBSCs by G-CSF significantly improves LV systolic function and microcirculation, compared with those receiving only PCI in patients with AMI. In this study, we compared perfusion changes and their correlation with LV function after stem cell therapy.
Methods and Results: Among 50 AMI patients enrolled, 31 patients who took both baseline cardiac MRI and myocardial SPECT after primary PCI for the culprit lesion and completed 6 month follow-up were evaluated; stem-cell infusion (n=18) and the control (n=13). Myocardial SPECT was performed according to rest 201Tl-dipyridamole and stress 99mTc-sestamibi gated protocol. The segment with the highest mean signal intensity was considered normal (100%); intraindividually all other segments were adjusted correspondingly by an automatic measurement. Summed stress score (SSS) and summed rest score (SRS) were also obtained.
The cell infusion group showed a significant additive improvement in perfusion score compared with controls (change of SSS: -7.3 ± 6.1 vs. -2.3 ± 5.9, p=0.03, change of SRS: -3.8 ± 4.5mL vs. -2.2 ± 3.7, p=0.26). This difference mainly comes from the response of the segments previously considered as nonviable (areas with < 50% of maximal thallium uptake) and nonreversible (rest minus stress perfusion values < 7%), of which mean changes in stress segmental thallium uptake were +2.9 ± 6.6% vs. -3.0 ± 11.6% (p=0.008).
The changes in SSS were significantly correlated with improvement of LV ejection fraction following cell infusion (r = 0.48, p = 0.001). Finally, significant improvement of wall motion was observed in the cell infusion group (wall motion score index: 1.62 ± 0.34 to 1.56 ± 0.37, p=0.04), which showed a prominent interaction with changes in the severely affected segment (51-75%, p = 0.048).
Conclusion: Improvement of myocardial perfusion might be a plausible mechanism of stem cell therapy mobilized by G-CSF.
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