CT for Evaluation of Myocardial Cell Therapy in Heart Failure A Comparison With CMR Imaging

Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA.
JACC. Cardiovascular imaging (Impact Factor: 7.19). 12/2011; 4(12):1284-93. DOI: 10.1016/j.jcmg.2011.09.013
Source: PubMed


The aim of this study was to use multidetector computed tomography (MDCT) to assess therapeutic effects of myocardial regenerative cell therapies.
Cell transplantation is being widely investigated as a potential therapy in heart failure. Noninvasive imaging techniques are frequently used to investigate therapeutic effects of cell therapies in the preclinical and clinical settings. Previous studies have shown that cardiac MDCT can accurately quantify myocardial scar tissue and determine left ventricular (LV) volumes and ejection fraction (LVEF).
Twenty-two minipigs were randomized to intramyocardial injection of phosphate-buffered saline (placebo, n = 9) or 200 million mesenchymal stem cells (MSC, n = 13) 12 weeks after myocardial infarction (MI). Cardiac magnetic resonance and MDCT acquisitions were performed before randomization (12 weeks after MI induction) and at the study endpoint 24 weeks after MI induction. None of the animals received medication to control the intrinsic heart rate during first-pass acquisitions for assessment of LV volumes and LVEF. Delayed-enhancement MDCT imaging was performed 10 min after contrast delivery. Two blinded observers analyzed MDCT acquisitions.
MDCT demonstrated that MSC therapy resulted in a reduction of infarct size from 14.3 ± 1.2% to 10.3 ± 1.5% of LV mass (p = 0.005), whereas infarct size increased in nontreated animals (from 13.8 ± 1.3% to 16.5 ± 1.5%; p = 0.02) (placebo vs. MSC; p = 0.003). Both observers had excellent agreement for infarct size (r = 0.96; p < 0.001). LVEF increased from 32.6 ± 2.2% to 36.9 ± 2.7% in MSC-treated animals (p = 0.03) and decreased in placebo animals (from 33.3 ± 1.4% to 29.1 ± 1.5%; p = 0.01; at week 24: placebo vs. MSC; p = 0.02). Infarct size, end-diastolic LV volume, and LVEF assessed by MDCT compared favorably with those assessed by cardiac magnetic resonance acquisitions (r = 0.70, r = 0.82, and r = 0.902, respectively; p < 0.001).
This study demonstrated that cardiac MDCT can be used to evaluate infarct size, LV volumes, and LVEF after intramyocardial-delivered MSC therapy. These findings support the use of cardiac MDCT in preclinical and clinical studies for novel myocardial therapies.

Download full-text


Available from: Karl H Schuleri
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Computed tomography angiography (CTA) of the heart is a rapidly evolving application for comprehensive assessment of coronary arterial anatomy, myocardial function, perfusion, and myocardial viability. Thus, cardiac CTA is capable of retrieving the most critical information for guiding the management of patients with suspected coronary heart disease (CHD). Ongoing technologic advancements have allowed acquiring such information within minutes, at radiation doses that are lower than those from conventional computed tomography imaging or common nuclear imaging techniques. Cardiac CTA has positioned itself as an imaging modality that may be well suited to fulfill central needs of cardiovascular medicine. This article reviews the evidence for the clinical utility of cardiac CTA in patients with suspected CHD.
    Full-text · Article · Apr 2012 · Journal of Nuclear Cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiac mapping is a perfect example of the evolution of science and practice in medicine and its related changes and future perspectives. Over the past decade multi-modality and multi-dimensional imaging and its applications in diagnostic and interventional electrophysiology - such as cardiac computed tomography, cardiac magnetic resonance imaging and positron emission tomography - have transformed current practice in a way that was previously unimaginable. Furthermore, the combination of these techniques with image integration and fusion on one hand and development of large number of pharmaceuticals and tracers on the other has taken mapping and imaging beyond the whole body, to subcellular levels.This review discusses some aspects of the advances in the modalities used for accurate diagnosis and equally effective therapies that have resulted in improvements in basic and clinical electrophysiology and its outcomes. Furthermore, the potential future outlook and expectations are briefly discussed to provide a picture of what the future holds in this field.
    No preview · Chapter · Dec 2012
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cell- and molecule-based therapeutic strategies to support wound healing and regeneration after myocardial infarction (MI) are under development. These emerging therapies aim at sustained preservation of ventricular function by enhancing tissue repair after myocardial ischaemia and reperfusion. Such therapies will benefit from guidance with regard to timing, regional targeting, suitable candidate selection, and effectiveness monitoring. Such guidance is effectively obtained by non-invasive tomographic imaging. Infarct size, tissue characteristics, muscle mass, and chamber geometry can be determined by magnetic resonance imaging and computed tomography. Radionuclide imaging can be used for the tracking of therapeutic agents and for the interrogation of molecular mechanisms such as inflammation, angiogenesis, and extracellular matrix activation. This review article portrays the hypothesis that an integrated approach with an early implementation of structural and molecular tomographic imaging in the development of novel therapies will provide a framework for achieving the goal of improved tissue repair after MI.
    Preview · Article · May 2013 · European Heart Journal Cardiovascular Imaging
Show more