Bone Marrow Cells Improve Coronary Flow Reserve in Ischemic Nonrevascularized Myocardium

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorASSUNCAO-JR, Antonildes N.
dc.contributor.authorROCHITTE, Carlos Eduardo
dc.contributor.authorKWONG, Raymond Y.
dc.contributor.authorGOWDAK, Luis Henrique Wolff
dc.contributor.authorKRIEGER, Jose Eduardo
dc.contributor.authorJEROSCH-HEROLD, Michael
dc.date.accessioned2022-08-12T17:05:54Z
dc.date.available2022-08-12T17:05:54Z
dc.date.issued2022
dc.description.abstractOBJECTIVES This study investigated whether intramyocardial bone marrow-derived hematopoietic progenitor cells (BMCs) increase coronary flow reserve (CFR) in ischemic myocardial regions where direct revascularization was unsuitable. BACKGROUND Patients with diffuse coronary artery disease frequently undergo incomplete myocardial revascularization, which increases their risk for future adverse cardiovascular outcomes. The residual regional ischemia related to both untreated epicardial lesions and small vessel disease usually contributes to the disease burden. METHODS The MiHeart/IHD study randomized patients with diffuse coronary artery disease undergoing incomplete coronary artery bypass grafting to receive BMCs or placebo in ischemic myocardial regions. After the procedure, 78 patients underwent cardiovascular magnetic resonance (CMR) at 1, 6, and 12 months and were included in this cardiac magnetic resonance substudy with perfusion quantification. Segments were classified as target (injected), adjacent (surrounding the injection site), and remote from injection site. RESULTS Of 1,248 segments, 269 were target (22%), 397 (32%) adjacent, and 582 (46%) remote. The target had significantly lower CFR at baseline (1.40 +/- 0.79 vs 1.64 +/- 0.89 in adjacent and 1.79 +/- 0.79 in remote; both P < 0.05). BMCs significantly increased CFR in target and adjacent segments at 6 and 12 months compared with placebo. In target regions, there was a progressive treatment effect (27.1% at 6 months, P = 0.037, 42.2% at 12 months, P = 0.001). In the adjacent segments, CFR increased by 21.8% (P = 0.023) at 6 months, which persisted until 12 months (22.6%; P = 0.022). Remote segments in both the BMC and placebo groups experienced similar improvements in CFR (not significant at 12 months compared with baseline). CONCLUSIONS BMCs, injected in severely ischemic regions unsuitable for direct revascularization, led to the largest CFR improvements, which progressed up to 12 months, compared with smaller but persistent CFR changes in adjacent and no improvement in remote segments. (J Am Coll Cardiol Img 2022;15:812-824) (c) 2022 The Authors.eng
dc.description.indexMEDLINEeng
dc.description.sponsorshipMinistry of Health of Brazil (FINEP) [0-1-04-0967-0-0]
dc.identifier.citationJACC-CARDIOVASCULAR IMAGING, v.15, n.5, p.812-824, 2022
dc.identifier.doi10.1016/j.jcmg.2021.12.011
dc.identifier.eissn1876-7591
dc.identifier.issn1936-878X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/48357
dc.language.isoeng
dc.publisherELSEVIER SCIENCE INCeng
dc.relation.ispartofJacc-Cardiovascular Imaging
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright ELSEVIER SCIENCE INCeng
dc.subjectbone marrow-derived hematopoietic progenitor cellseng
dc.subjectcardiac magnetic resonanceeng
dc.subjectcoronary artery bypass grafteng
dc.subjectcoronary artery diseaseeng
dc.subjectcoronary flow reserveeng
dc.subject.otherheart-diseaseeng
dc.subject.otherblood-floweng
dc.subject.othertissue perfusioneng
dc.subject.otherprogenitor cellseng
dc.subject.otherartery-diseaseeng
dc.subject.otherrevascularizationeng
dc.subject.otherdeliveryeng
dc.subject.othertherapyeng
dc.subject.otherinjectioneng
dc.subject.otherseverityeng
dc.subject.wosCardiac & Cardiovascular Systemseng
dc.subject.wosRadiology, Nuclear Medicine & Medical Imagingeng
dc.titleBone Marrow Cells Improve Coronary Flow Reserve in Ischemic Nonrevascularized Myocardiumeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryisous
hcfmusp.author.externalKWONG, Raymond Y.:Brigham & Womens Hosp, Harvard Med Sch, Div Cardiovasc Med & Radiol, Boston, MA USA
hcfmusp.author.externalJEROSCH-HEROLD, Michael:Brigham & Womens Hosp, Harvard Med Sch, Div Cardiovasc Med & Radiol, Boston, MA USA
hcfmusp.citation.scopus4
hcfmusp.contributor.author-fmusphcANTONILDES NASCIMENTO ASSUNCAO JUNIOR
hcfmusp.contributor.author-fmusphcCARLOS EDUARDO ROCHITTE
hcfmusp.contributor.author-fmusphcLUIS HENRIQUE WOLFF GOWDAK
hcfmusp.contributor.author-fmusphcJOSE EDUARDO KRIEGER
hcfmusp.description.beginpage812
hcfmusp.description.endpage824
hcfmusp.description.issue5
hcfmusp.description.volume15
hcfmusp.origemWOS
hcfmusp.origem.pubmed35512954
hcfmusp.origem.scopus2-s2.0-85128626188
hcfmusp.origem.wosWOS:000808099000013
hcfmusp.publisher.cityNEW YORKeng
hcfmusp.publisher.countryUSAeng
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