Cell therapy in reperfused acute myocardial infarction does not improve the recovery of perfusion in the infarcted myocardium; a cardiac magnetic resonance imaging study

Purpose We investigated the effects of cell therapy on myocardial perfusion recovery after primary percutaneous coronary intervention (PCI) treated acute myocardial infarction (AMI). Materials and methods In this HEBE trial substudy (IRB approved, trial registry number ISRCTN95796863), we assessed the effects of intracoronary infusion with bone marrow-derived mononuclear cells (BMMCs) or peripheral blood-derived mononuclear cells (PBMCs) on myocardial perfusion recovery, using cardiac magnetic resonance (MR) imaging after revascularization. In 152 PCI-treated AMI-patients, cardiac MR was performed after informed consent, before randomization to BMMCs, PBMCs or standard therapy (control), and was repeated after 4 months follow-up. Cardiac MR imaging consisted of cine imaging, rest first-pass perfusion and late gadolinium enhancement (LGE). Perfusion was evaluated semi-quantitatively from signal intensity-time curves by calculating the relative upslope (% signal intensity change). The relative upslope was calculated for the myocardial infarct (MI) core, adjacent border zone and remote myocardium. Perfusion differences between groups or between baseline and follow-up were assessed with Wilcoxon signed rank test or Mann-Whitney U-test. Results At baseline, median myocardial perfusion differed between MI core (6.0 [4.1-8.0]%), border zone (8.4 [6.4-10.2]%) and remote myocardium (12.2 [10.5-15.9]%; all pvalues <0.001), with equal distribution among treatment groups. At follow-up, these inter-regional differences persisted (all p-values <0.001). No difference in perfusion recovery was found between the three treatment groups for any region. Conclusion After revascularized STEMI, cell therapy does not augment the recovery of resting perfusion in either MI core or border zone.