Adenosine stress perfusion cardiac magnetic resonance imaging in patients undergoing intracoronary bone marrow cell transfer after ST-elevation myocardial infarction: the BOOST-2 perfusion substudy

Abstract

Aims

In the placebo-controlled, double-blind BOne marrOw transfer to enhance ST-elevation infarct regeneration (BOOST) 2 trial, intracoronary autologous bone marrow cell (BMC) transfer did not improve recovery of left ventricular ejection fraction (LVEF) at 6 months in patients with ST-elevation myocardial infarction (STEMI) and moderately reduced LVEF. Regional myocardial perfusion as determined by adenosine stress perfusion cardiac magnetic resonance imaging (S-CMR) may be more sensitive than global LVEF in detecting BMC treatment effects. Here, we sought to evaluate (i) the changes of myocardial perfusion in the infarct area over time (ii) the effects of BMC therapy on infarct perfusion, and (iii) the relation of infarct perfusion to LVEF recovery at 6 months.

Methods and results

In 51 patients from BOOST-2 (placebo, n = 10; BMC, n = 41), S-CMR was performed 5.1 ± 2.9 days after PCI (before placebo/BMC treatment) and after 6 months. Infarct perfusion improved from baseline to 6 months in the overall patient cohort as reflected by the semi-quantitative parameters, perfusion defect–infarct size ratio (change from 0.54 ± 0.20 to 0.43 ± 0.22; P = 0.006) and perfusion defect–upslope ratio (0.54 ± 0.23 to 0.68 ± 0.22; P < 0.001), irrespective of randomised treatment. Perfusion defect–upslope ratio at baseline correlated with LVEF recovery (r = 0.62; P < 0.001) after 6 months, with a threshold of 0.54 providing the best sensitivity (79%) and specificity (74%) (area under the curve, 0.79; 95% confidence interval, 0.67–0.92).

Conclusion

Infarct perfusion improves from baseline to 6 months and predicts LVEF recovery in STEMI patients undergoing early PCI. Intracoronary BMC therapy did not enhance infarct perfusion in the BOOST-2 trial.

Graphic abstract

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Acknowledgements

We would like to thank the following physicians, research assistants, and study nurses for their support of the trial: I. Schridde and S. Tammen (Hannover); E. Erdmann, M. Halbach, B. Krausgrill, and T. Schewior (Cologne); B. Blank (Berlin); W. Bethge (Tübingen); R. Bülow, M. Heukäufer, and T. Neumann (Greifswald); A. Dösch (Heidelberg); and U. Sechtem (Stuttgart). We thank F.J. Neumann (Bad Krozingen) and G. Steinhoff (Rostock) who served as members of the Data and Safety Monitoring Board.

Funding

This work was supported by the German Research Foundation (DR 148/13-1 Programme Clinical Trials), the Alfried Krupp von Bohlen and Halbach-Foundation, and the Robert Bosch Stiftung.

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Correspondence to Simon Greulich.

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Seitz, A., Wollert, K.C., Meyer, G.P. et al. Adenosine stress perfusion cardiac magnetic resonance imaging in patients undergoing intracoronary bone marrow cell transfer after ST-elevation myocardial infarction: the BOOST-2 perfusion substudy. Clin Res Cardiol 109, 539–548 (2020). https://doi.org/10.1007/s00392-019-01537-4

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Keywords

  • St-elevation myocardial infarction
  • Adenosine stress perfusion cardiac magnetic resonance imaging
  • Bone marrow cell therapy