Since Clinical Studies Of Bone Marrow Mononuclear Cell Transplantation In The Treatment Of Coronary Heart Disease Old Myocardial Infarction

Partâ… :The safety study of first stage about coronary artery bypass graft combined with autologous bone marrow mononuclear cell transplant in coronary artery disease treatment.Objective:To use coronary artery bypass graft and autologous bone marrow mononuclear cell transplant to cure patients with heart failure caused by old myocardial infarction,and to evaluate the safety and intermediate stage clinical effect.Methods:The change of left ventricular function,adverse events,live time and long-time follow up information were evaluated the patients with heart failure caused by old myocardial infarction who experienced coronary artery bypass graft and autologous bone marrow mononuclear cell transplant.Result:17 patients were accepted the treatment of coronary artery bypass graft and autologous bone marrow mononuclear cell transplant.One died of postoperative cerebral embolism.No myocardial infarction,liver or renal failure,and fresh malignant arrhythmia were occurred.16 patients were survived,left ventrical ejection fraction were raised.No change was occurred in LVEDD,and the change of heart function and the symptom of angina were obviously and had statistical significance.Conclusion:Using coronary artery bypass graft and autologous bone marrow mononuclear cell transplant to cure patients with heart failure caused by old myocardial infarction is feasible.The early metaphase follow up results showed that the method is safe. Partâ…¡:Coronary artery bypass graft and autologous bone marrow mononuclear cell transplant to cure patients with heart failure caused by old myocardial infarction in the randomize and double blind paralleled clinical studyObjective:To evaluate the change of heart function,angina,quality of life,and long-time survival rate in the patients with heart failure caused by old myocardial infarction that experienced coronary artery bypass graft and autologous bone marrow mononuclear cell transplant.Methods:The patients with heart failure caused by old myocardial infarction were included in the prospective test.Postoperative abilities of volume and function assessment were measured by 3D-echocardiography and MRI.SPECT was employed to detect the change of infarct size and MRI was employed to detect the change of segment vertical wall thickening.The change of early clinical symptom,exercise tolerance change,and long-time follow up information were evaluated in postoperative early stage.Results:The 20 patients included 9 in treatment group and 11 in control group.No death was found in the early stage and 6 month follow-up.Postoperative LVEF obtained by MRI were higher than preoperative group(P=0.006),but no statistical significance were found between two groups.The change of stroke volume,heart stroke,cardiac index,left ventricular quality and segment ventricular wall thickening rate in stem cell treatment group were higher than control group(p values were 0.019, 0.047,0.048,0.024 and 0.001 respectively).Postoperative LVEF obtained by 3D-echocardiography was higher than preoperative group(p=0.023).However, LVEDD,LVESD and LVESV is lower than preoperative group(p values were 0.001, 0.001 and 0.019 respectively).Postoperative perfusion defect obtained by SPECT was lower than preoperative group(p=0.094).Postoperative total segment perfusion integral obtained by SPECT was lower than preoperative group(p=0.096). Postoperative distance of 6 minutes walking experiments was raised than preoperative group(p=0.002).Postoperative BNP had no statistical significance compared with preoperative group.Conclusion:To use coronary artery bypass graft and autologous bone marrow mononuclear cell transplant to cure patients with heart failure caused by old myocardial infarction is safe.6 months follow-up results showed the elevation of stroke volume,cardiac output,cardiac index,left ventricular mass,segment ventricular wall thickening rate in stem cell treatment group were higher than control group. Partâ…¢:Evaluation of application of MRI in the diagnosis of heart failure caused by old myocardial infarction and in the assessment of therapeutic effects of stem cell transplantation.Objectives:to evaluate the application of MRI in the diagnosis of heart failure induced by old myocardial infarction and in the assessment of therapeutic effects of stem cell transplantation.Methods:preoperative LVEDV,LVESV and LVEF were measured by 3D-echocardiography,gated SPECT and MRI in patients with heart failure induced by old myocardial infarction.The comparison of results obtained by those different methods was investigated.¹⁸F-FDG myocardial metabolism imaging and late contrast-enhanced MRI were employed to detect viable myocardium,and the accuracy of MRI was analyzed.The changes of left ventricular volumes and heart functions after stem cell transplantation were evaluated by MRI.Results:preoperative LVEDV and LVEF obtained by ventriculography mismatched with those data obtained by MRI,with higher readings in ventriculography;the LVESV obtained by the above two methods were correlated well(r=0.62,p=0.014). Preoperative LVEDV,LVESV and LVEF obtained by gated SPECT had the closest results to those obtained by MRI(r=0.65,r=0.66,r=0.64,p values were 0.002,0.002 and 0.043 respectively).Preoperative LVEDV,LVESV and LVEF obtained by 3D-echocardiography had moderate correlation with MRI(r=0.61,r=0.62,r=0.62,p values were 0.036,0.014 and 0.007 respectively).The interpretion of late contrast-enhanced MRI had good agreement with ¹⁸F-FDG myocardial metabolism imaging SPECT in assessment of myocardial viability,kappa value was 0.446(P＜0.001).Compared with ¹⁸F-FDG myocardial metabolism imaging,which was taken as a gold standard,the sensitivity of late contrast-enhanced MRI was 68.3%and the specificity was 92.5%.The changes of segmental wall thickness were difference between stem cell treatment group and control group(p=0.044).Conclusions:MRI can accurately detect left ventricular volume and function for patients with old myocardial infarction.The left ventricular volume and function tested by gated SPECT and 3D-echocardiography were correlated well with MRI, while the left ventricular volumes and functions between ventriculography and MRI differed significantly.As for the assessment of viable myocardium after myocardial infarction,MRI has specificity similar to ¹⁸F-FDG SPECT but sensitivity inferior to ¹⁸F-FDG SPECT.MRI had dominance at evaluating the therapeutic effects of stem cell transplantation in heart in that MRI can provide morphologic,structural and functional indices at the same time.Moreover,due to its high spatial resolution,MRI can detect subtle changes in wall motion and thickness and is capable of being applied to the evaluation of early outcomes after stem cell transplantation.