Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPASSUNCAO-JR, Antonildes N.ROCHITTE, Carlos EduardoKWONG, Raymond Y.GOWDAK, Luis Henrique WolffKRIEGER, Jose EduardoJEROSCH-HEROLD, Michael2022-08-122022-08-122022JACC-CARDIOVASCULAR IMAGING, v.15, n.5, p.812-824, 20221936-878Xhttps://observatorio.fm.usp.br/handle/OPI/48357OBJECTIVES 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.engrestrictedAccessbone marrow-derived hematopoietic progenitor cellscardiac magnetic resonancecoronary artery bypass graftcoronary artery diseasecoronary flow reserveheart-diseaseblood-flowtissue perfusionprogenitor cellsartery-diseaserevascularizationdeliverytherapyinjectionseverityarticleCopyright ELSEVIER SCIENCE INC10.1016/j.jcmg.2021.12.011Cardiac & Cardiovascular SystemsRadiology, Nuclear Medicine & Medical Imaging1876-7591