Background: This study was undertaken to evaluate the hypothesis that treatment with granulocyte colony-stimu-lating factor(G-CSF) to mobilize bone marrow cells(BMCs) is feasible and safe and promotes neovascularizati...Background: This study was undertaken to evaluate the hypothesis that treatment with granulocyte colony-stimu-lating factor(G-CSF) to mobilize bone marrow cells(BMCs) is feasible and safe and promotes neovascularization and myocardial function in patients with acute myocardial infarction. Methods: Fourteen patients in the treatment group and 9 patients in the control group were enrolled in this prospective, nonrandomized, open-label study. Forty-eight hours after successful recanalization and stent implantation, the patients of the treatment group received 10 μg/kg body weight per day G-CSF subcutaneously for mean treatment duration of 7.0±1.0 days. Nine patients fulfilled the entry criteria but refused participation and served therefore as control group. In both groups, regional wall motion and perfusion was evaluated with electrocardiogram-gated sestamibi single-photon emission computed tomography imaging and ejection fraction with radionuclidventriculography before discharge and after 3 months. Results: No severe side effects of G-CSF treatment were observed. There was a significant improvement of the regional wall motion and perfusion within the treatment group(P< .0001) and between the treatment and control group(P< .05 and P< .01, respectively). Ejection fraction in the treatment group increased from 0.40±0.11 to 0.48±0.13(P< .01), whereas in the control group, ejection fraction increased from 0.40±0.13 to 0.43±0.13(P=.049). A control angiography of the treatment group after 12.4±6.6 months showed an in-stent restenosis in 1 patient. Conclusion: In patients with acute myocardial infarction, treatment with G-CSF to mobilize BMCs is feasible and safe and seems to be effective under clinical conditions. The therapeutic effect might be attributed to BMC-associated promotion of myocardial regeneration and neovasculariza-tion.展开更多
Objective: To validate an intracoronary Doppler ultrasound device for high intensity transient signals(HITS) detection and to assess the incidence of HITS during percutaneous coronary intervention(PCI). Methods and Re...Objective: To validate an intracoronary Doppler ultrasound device for high intensity transient signals(HITS) detection and to assess the incidence of HITS during percutaneous coronary intervention(PCI). Methods and Results: In an in vitro model, particle count and number of HITS detected by an intracoronary 0.014 inch Doppler wire were closely correlated(r=0.97, p< 0.001). In the clinical study, 32 patients(mean(SD) age 61(11) years; 23 men, nine women) with coronary artery disease were treated with balloon dilatation and stent implantation for a single vessel stenosis. In these patients HITS were detected during PCI in 84%(27 of 32). Reproducibility(r=0.99, p< 0.001) and interobserver agreement(r=0.84, p< 0.001)of HITS counts were significant. The number of HITS after stent implantation was significantly higher than after balloon dilatation(11(7) v 2(4), p< 0.001). Postprocedural coronary flow velocity reserve(CFVR) was< 2.0 in 55%(16 of 29) of all patients after balloon dilatation and< 2.0 in 23%(six of 26) after stent implantation. The number of HITS after stent implantation did not differ significantly between patients with CFVR< 2.0 and patients with CFVR ≥2.0(12(8) v 10(7), not significant). Conclusions: Embolic particles can be detected as HITS by an intracoronary Doppler ultrasound device. Coronary microembolism is often observed during PCI, especially after stent implantation. However, the incidence of HITS alone does not explain a reduced CFVR after PCI.展开更多
文摘Background: This study was undertaken to evaluate the hypothesis that treatment with granulocyte colony-stimu-lating factor(G-CSF) to mobilize bone marrow cells(BMCs) is feasible and safe and promotes neovascularization and myocardial function in patients with acute myocardial infarction. Methods: Fourteen patients in the treatment group and 9 patients in the control group were enrolled in this prospective, nonrandomized, open-label study. Forty-eight hours after successful recanalization and stent implantation, the patients of the treatment group received 10 μg/kg body weight per day G-CSF subcutaneously for mean treatment duration of 7.0±1.0 days. Nine patients fulfilled the entry criteria but refused participation and served therefore as control group. In both groups, regional wall motion and perfusion was evaluated with electrocardiogram-gated sestamibi single-photon emission computed tomography imaging and ejection fraction with radionuclidventriculography before discharge and after 3 months. Results: No severe side effects of G-CSF treatment were observed. There was a significant improvement of the regional wall motion and perfusion within the treatment group(P< .0001) and between the treatment and control group(P< .05 and P< .01, respectively). Ejection fraction in the treatment group increased from 0.40±0.11 to 0.48±0.13(P< .01), whereas in the control group, ejection fraction increased from 0.40±0.13 to 0.43±0.13(P=.049). A control angiography of the treatment group after 12.4±6.6 months showed an in-stent restenosis in 1 patient. Conclusion: In patients with acute myocardial infarction, treatment with G-CSF to mobilize BMCs is feasible and safe and seems to be effective under clinical conditions. The therapeutic effect might be attributed to BMC-associated promotion of myocardial regeneration and neovasculariza-tion.
文摘Objective: To validate an intracoronary Doppler ultrasound device for high intensity transient signals(HITS) detection and to assess the incidence of HITS during percutaneous coronary intervention(PCI). Methods and Results: In an in vitro model, particle count and number of HITS detected by an intracoronary 0.014 inch Doppler wire were closely correlated(r=0.97, p< 0.001). In the clinical study, 32 patients(mean(SD) age 61(11) years; 23 men, nine women) with coronary artery disease were treated with balloon dilatation and stent implantation for a single vessel stenosis. In these patients HITS were detected during PCI in 84%(27 of 32). Reproducibility(r=0.99, p< 0.001) and interobserver agreement(r=0.84, p< 0.001)of HITS counts were significant. The number of HITS after stent implantation was significantly higher than after balloon dilatation(11(7) v 2(4), p< 0.001). Postprocedural coronary flow velocity reserve(CFVR) was< 2.0 in 55%(16 of 29) of all patients after balloon dilatation and< 2.0 in 23%(six of 26) after stent implantation. The number of HITS after stent implantation did not differ significantly between patients with CFVR< 2.0 and patients with CFVR ≥2.0(12(8) v 10(7), not significant). Conclusions: Embolic particles can be detected as HITS by an intracoronary Doppler ultrasound device. Coronary microembolism is often observed during PCI, especially after stent implantation. However, the incidence of HITS alone does not explain a reduced CFVR after PCI.
