TY - JOUR
T1 - Does transendocardial injection of mesenchymal stem cells improve myocardial function locally or globally?
T2 - An analysis from the percutaneous stem cell injection delivery effects on neomyogenesis (POSEIDON) randomized trial
AU - Suncion, Viky Y.
AU - Ghersin, Eduard
AU - Fishman, Joel E.
AU - Zambrano, Juan Pablo
AU - Karantalis, Vasileios
AU - Mandel, Nicole
AU - Nelson, Katarina H.
AU - Gerstenblith, Gary
AU - Difede Velazquez, Darcy L.
AU - Breton, Elayne
AU - Sitammagari, Kranthi
AU - Schulman, Ivonne H.
AU - Taldone, Sabrina N.
AU - Williams, Adam R.
AU - Sanina, Cristina
AU - Johnston, Peter V.
AU - Brinker, Jeffrey
AU - Altman, Peter
AU - Mushtaq, Muzammil
AU - Trachtenberg, Barry
AU - Mendizabal, Adam M.
AU - Tracy, Melissa
AU - Da Silva, Jose
AU - McNiece, Ian K.
AU - Lardo, Alberto C.
AU - George, Richard T.
AU - Hare, Joshua M.
AU - Heldman, Alan W.
PY - 2014
Y1 - 2014
N2 - Rationale: Transendocardial stem cell injection (TESI) with mesenchymal stem cells improves remodeling in chronic ischemic cardiomyopathy, but the effect of the injection site remains unknown. Objective: To address whether TESI exerts its effects at the site of injection only or also in remote areas, we hypothesized that segmental myocardial scar and segmental ejection fraction improve to a greater extent in injected than in noninjected segments. Methods and results: Biplane ventriculographic and endocardial tracings were recorded. TESI was guided to 10 sites in infarct-border zones. Sites were mapped according to the 17-myocardial segment model. As a result, 510 segments were analyzed in 30 patients before and 13 months after TESI. Segmental early enhancement defect (a measure of scar size) was reduced by TESI in both injected (-43.7±4.4%; n=95; P<0.01) and noninjected segments (-25.1±7.8%; n=148; P<0.001; between-group comparison P<0.05). Conversely, segmental ejection fraction (a measure of contractile performance) improved in injected scar segments (19.9±3.3-26.3±3.5%; P=0.003) but not in noninjected scar segments (21.3±2.6-23.5±3.2%; P=0.20; between-group comparison P<0.05). Furthermore, segmental ejection fraction in injected scar segments improved to a greater degree in patients with baseline segmental ejection fraction <20% (12.1±1.2-19.9±2.7%; n=18; P=0.003), versus <20% (31.7±3.4-35.5±3.3%; n=12; P=0.33, between-group comparison P<0.0001). Conclusions: These findings illustrate a dichotomy in regional responses to TESI. Although scar size reduction was evident in all scar segments, scar size reduction and ventricular functional responses preferentially occurred at the sites of TESI versus non-TESI sites. Furthermore, improvement was greatest when segmental left ventricular dysfunction was severe.
AB - Rationale: Transendocardial stem cell injection (TESI) with mesenchymal stem cells improves remodeling in chronic ischemic cardiomyopathy, but the effect of the injection site remains unknown. Objective: To address whether TESI exerts its effects at the site of injection only or also in remote areas, we hypothesized that segmental myocardial scar and segmental ejection fraction improve to a greater extent in injected than in noninjected segments. Methods and results: Biplane ventriculographic and endocardial tracings were recorded. TESI was guided to 10 sites in infarct-border zones. Sites were mapped according to the 17-myocardial segment model. As a result, 510 segments were analyzed in 30 patients before and 13 months after TESI. Segmental early enhancement defect (a measure of scar size) was reduced by TESI in both injected (-43.7±4.4%; n=95; P<0.01) and noninjected segments (-25.1±7.8%; n=148; P<0.001; between-group comparison P<0.05). Conversely, segmental ejection fraction (a measure of contractile performance) improved in injected scar segments (19.9±3.3-26.3±3.5%; P=0.003) but not in noninjected scar segments (21.3±2.6-23.5±3.2%; P=0.20; between-group comparison P<0.05). Furthermore, segmental ejection fraction in injected scar segments improved to a greater degree in patients with baseline segmental ejection fraction <20% (12.1±1.2-19.9±2.7%; n=18; P=0.003), versus <20% (31.7±3.4-35.5±3.3%; n=12; P=0.33, between-group comparison P<0.0001). Conclusions: These findings illustrate a dichotomy in regional responses to TESI. Although scar size reduction was evident in all scar segments, scar size reduction and ventricular functional responses preferentially occurred at the sites of TESI versus non-TESI sites. Furthermore, improvement was greatest when segmental left ventricular dysfunction was severe.
KW - cells
KW - magnetic resonance imaging
KW - myocardial infarction
KW - tomography
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UR - http://www.scopus.com/inward/citedby.url?scp=84898892501&partnerID=8YFLogxK
U2 - 10.1161/CIRCRESAHA.114.302854
DO - 10.1161/CIRCRESAHA.114.302854
M3 - Article
C2 - 24449819
AN - SCOPUS:84898892501
SN - 0009-7330
VL - 114
SP - 1292
EP - 1301
JO - Circulation research
JF - Circulation research
IS - 8
ER -