Cor Vasa 2005, 46(5)

Repair of infarcted myocardium by autologous mononuclear bone marrow cell transplantation: the role of quantitative Tc-99m-MIBI SPECT/F-18-FDG PET in the monitoring of therapy

Milan Kamínek^1,*, Jaroslav Meluzín², Ladislav Groch², Stanislav Janoušek³, Jiří Mayer⁴, Jiří Prášek⁵, Jaroslav Staníček⁶, Miroslav Mysliveček¹

¹ Klinika nukleární medicíny, Fakultní nemocnice Olomouc, Olomouc

² I. interní-kardioangiologická klinika, Fakultní nemocnice u sv. Anny, Brno

³ Interní-kardiologická klinika

⁴ Interní-hematoonkologická klinika

⁵ Oddělení nukleární medicíny, Fakultní nemocnice Brno-Bohunice

⁶ Oddělení nukleární medicíny, Masarykův onkologický ústav, Brno, Česká republika

The aim of this study was to assess the role of MIBI SPECT/FDG PET imaging in the monitoring of infarcted myocardium therapy by autologous mononuclear bone marrow cell transplantation. We analyzed a total of 25 patients with acute myocardial infarction (AMI) associated with irreversible injury after primary percutaneous coronary intervention (at least two dysfunctional segments with no contractile reserve on dobutamine echocardiography and < 55% of maximal MIBI or < 50% of maximal FDG uptake). In addition to standard therapy, 16 patients were treated by cell transplantation, while 9 patients were randomly included into the control group. Using 4D-MSPECT software, we quantified MIBI/FDG uptake and gated SPECT left ventricular ejection fraction (LVEF) before cell therapy and 3 months later. In the transplantation group, average LVEF slightly improved from 39.5% ± 10.3% to 43.1% ± 10.5%; in the control group, baseline LVEF was 38.8% ± 9.7% vs. 41.4% ± 10.1% three months later, p = NS. Among bone marrow cell-treated patients, we identified 6 responders (LVEF improved from 38.8% ± 13.5% to 49.6% ± 14%, p < 0.05) and 10 non-responders to therapy (LVEF 39.9% ± 9.5% vs. 39.8% ± 7.4%, p = NS). In the subgroup of responders to therapy, we usually observed the presence of dysfunctional segments with residual perfusion (30 %-55% of maximal MIBI uptake), and MIBI uptake > FDG uptake. Otherwise, among non-responders subgroup, there were only patients with very low MIBI uptake (< 30% of maximum) in the dysfunctional segments.

Keywords: Bone marrow cell transplantation; Myocardial infarction; Myocardial perfusion SPECT; FDG PET

Published: May 1, 2005  Show citation