摘要
Background Emerging evidence suggests that stem cells can be used to improvecardiac function in patients after acute myocardial infarction. In this randomized trial, we aimedto use Doppler tissue tracking and strain imaging to assess left ventricular segmental functionafter intracoronary transfer of autologous bone-marrow stem cells ( BMCs) for 6 months' follow up.Methods Twenty patients with acute myocardial infarction and anterior descending coronary arteryocclusion proven by angiography were double-blindedly randomized into intracoronary injection ofbone-marrow cell (treated, n = 9 ) or diluted serum ( control, n = 11) groups. GE vivid 7 andQ-analyze software were used to perform echocardiogram in both groups 1 week, 3 months and 6 monthsafter treatment. Three apical views of tissue Doppler imaging were acquired to measure peak systolicdisplacement ( D_s) and peak systolic strain (ε_(peak)) from 12 segments of LV walls. Leftventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume ( ESV) wereobtained by Simposon's biplane method. Results (1) 3 months later, D_a and ε_(peak) over theinfract-related region clearly increased in the BMCs group [D_8: (4.49 ±2.71) mm vs (7.56 ±2.95)mm, P < 0. 01; ε_(peak): ( - 13.40 ±6.00)% vs ( - 17.06 ± 6.05)% , P<0.01] , but not in thecontrol group [ D_8: (4.74 ±2.67) mm vs (5.01 ±3.23) mm, P >0.05; ε_(peak): ( - 13.84 ± 6.05) %vs ( - 15.04 ± 6.75) % , P > 0.05 ]. At the same time, D_s over the normal region also increased,but the D_8 enhancement was markedly higher in the BMCs group than that in the control group [ (3.21±3.17) mm vs (0.76 ± 1.94) mm, P <0.01 ]. Parameters remained steady from the 3rd to 6th month ineither group (P >0.05). (2) LVEF in treated and control groups were almost the same at baseline (1st week after PCI) [ (53.37 ± 8.92) % vs (53.51 ± 5.84) % , P > 0.05 ]. But 6 months later, LVEFin the BMCs group were clearly higher than that in the control group [(59.33 ± 12.91)% vs (50.30 ±8.30)%, P < 0.05 ]. (3) There were no evident difference in EDV or ESV between two groups atbaseline [ EDV; (113.74 ±23.24) ml vs (129.94 ±32.72) ml , P>0.05; ESV: (57.12 ±18.66) ml vs(62.09 ± 17.68) ml, P > 0.05 ]. Three months later, EDV and ESV in the control group were markedlygreater than those in the BMCs group [EDV; (154.89 ±46.34) ml vs (104.85 ±33.21) ml, P<0.05; ESV:(82.91 ±35.79) ml vs (49.54 ± 23.32) ml, P < 0.05 ]. But EDV and ESV did not change much from 3rdto 6th month in either group (P>0.05). Conclusions Emergency transplantation of autologous BMCs inpatients with acute myocardial infarction helps to improve global and regional contractility andattenuate post-infarction left ventricular remodeling. Tissue tracking and strain imaging providequick, simple and noninvasive methods for quantifying left ventricular segmental function in humans.
Background Emerging evidence suggests that stem cells can be used to improvecardiac function in patients after acute myocardial infarction. In this randomized trial, we aimedto use Doppler tissue tracking and strain imaging to assess left ventricular segmental functionafter intracoronary transfer of autologous bone-marrow stem cells ( BMCs) for 6 months' follow up.Methods Twenty patients with acute myocardial infarction and anterior descending coronary arteryocclusion proven by angiography were double-blindedly randomized into intracoronary injection ofbone-marrow cell (treated, n = 9 ) or diluted serum ( control, n = 11) groups. GE vivid 7 andQ-analyze software were used to perform echocardiogram in both groups 1 week, 3 months and 6 monthsafter treatment. Three apical views of tissue Doppler imaging were acquired to measure peak systolicdisplacement ( D_s) and peak systolic strain (ε_(peak)) from 12 segments of LV walls. Leftventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume ( ESV) wereobtained by Simposon's biplane method. Results (1) 3 months later, D_a and ε_(peak) over theinfract-related region clearly increased in the BMCs group [D_8: (4.49 ±2.71) mm vs (7.56 ±2.95)mm, P < 0. 01; ε_(peak): ( - 13.40 ±6.00)% vs ( - 17.06 ± 6.05)% , P<0.01] , but not in thecontrol group [ D_8: (4.74 ±2.67) mm vs (5.01 ±3.23) mm, P >0.05; ε_(peak): ( - 13.84 ± 6.05) %vs ( - 15.04 ± 6.75) % , P > 0.05 ]. At the same time, D_s over the normal region also increased,but the D_8 enhancement was markedly higher in the BMCs group than that in the control group [ (3.21±3.17) mm vs (0.76 ± 1.94) mm, P <0.01 ]. Parameters remained steady from the 3rd to 6th month ineither group (P >0.05). (2) LVEF in treated and control groups were almost the same at baseline (1st week after PCI) [ (53.37 ± 8.92) % vs (53.51 ± 5.84) % , P > 0.05 ]. But 6 months later, LVEFin the BMCs group were clearly higher than that in the control group [(59.33 ± 12.91)% vs (50.30 ±8.30)%, P < 0.05 ]. (3) There were no evident difference in EDV or ESV between two groups atbaseline [ EDV; (113.74 ±23.24) ml vs (129.94 ±32.72) ml , P>0.05; ESV: (57.12 ±18.66) ml vs(62.09 ± 17.68) ml, P > 0.05 ]. Three months later, EDV and ESV in the control group were markedlygreater than those in the BMCs group [EDV; (154.89 ±46.34) ml vs (104.85 ±33.21) ml, P<0.05; ESV:(82.91 ±35.79) ml vs (49.54 ± 23.32) ml, P < 0.05 ]. But EDV and ESV did not change much from 3rdto 6th month in either group (P>0.05). Conclusions Emergency transplantation of autologous BMCs inpatients with acute myocardial infarction helps to improve global and regional contractility andattenuate post-infarction left ventricular remodeling. Tissue tracking and strain imaging providequick, simple and noninvasive methods for quantifying left ventricular segmental function in humans.
