technetium-tc-99m-exametazime and Cardiomyopathy--Dilated

Between March 2003 and February 2005 cell therapy with mononuclear bone marrow cells (MBMC) was used in 38 and 4 patients with ischemic heart disease and dilated cardiomyopathy, respectively. Intracardiac administration of MBMC (87+/-12 millions) was carried out during coronary artery bypass surgery and/or left ventricular aneurysm resection (n=25) or in cardiac catheterization laboratory (n=17). For verification of cells fixation they were labeled with "Ceretec" 99mTc-HMPAO. Accumulation of labeled cells after 24 hours was 1.6+/-0.001%. After 6 months parameters of intracardiac hemodynamics and transitory myocardial perfusion defects improved significantly in all patients with ischemic heart disease.

Topics: Adult; Bone Marrow Transplantation; Cardiomyopathy, Dilated; Hemodynamics; Humans; Male; Middle Aged; Monocytes; Myocardial Ischemia; Technetium Tc 99m Exametazime; Treatment Outcome

Stem cell transplantation is an emerging method of treatment for patients with cardiovascular disease. There are few studies completed or ongoing on stem cell therapy in patients with idiopathic dilated cardiomyopathy (IDCM). Information on stem cell homing and distribution in the myocardium after transplantation might provide important insight into effectiveness of transplantation procedure.. To assess early engraftment, retention and migration of intracoronarily transplanted stem cells in the myocardium of patients with advanced dilated cardiomyopathy of non-ischaemic origin using stem cell labeling with (99m)Tc-exametazime (HMPAO).. Thirty-five patients with IDCM and advanced heart failure were included in the study. Autologous hematopoietic (CD34+) stem cells were harvested by peripheral blood apheresis after bone marrow stimulation, labeled with (99m)Tc-HMPAO, tested for viability and injected into coronary vessel supplying areas of myocardium selected by myocardial perfusion scintigraphy as dysfunctional yet viable. Imaging was performed 1h and 18h after transplantation.. Myocardial stem cell retention ranged from 0 to 1.44% on early and 0-0.97% on delayed imaging. Significant efflux of stem cells occurred from site of delivery in this time period (p<0.001). Stem cell viability was not affected by labeling.. Stem cell labeling with (99m)Tc-HMPAO is a feasible method for stem cell tracking after transplantation in patients with IDCM.

Topics: Adult; Cardiomyopathy, Dilated; Cell Movement; Cell Survival; Coronary Vessels; Female; Humans; Kinetics; Male; Stem Cell Transplantation; Stem Cells; Technetium Tc 99m Exametazime

Although stem cell therapy (SCT) is emerging as a potential treatment for patients with dilated cardiomyopathy (DCM), clinical response remains variable. Our objective was to determine whether baseline differences in circulating immunologic and nonimmunologic biomarkers may help to identify patients more likely to respond to intramyocardial injection of CD34(+)-based SCT.. We enrolled from January 3, 2011 to March 5, 2012 37 patients with longstanding DCM (left ventricular ejection fraction [LVEF] <40%, New York Heart Association functional class III) who underwent peripheral CD34(+) stem cell mobilization with granulocyte colony-stimulating factor (G-CSF) and collection by means of apheresis. CD34(+) cells were labeled with (99m)Tc-hexamethylpropyleneamine oxime to allow assessment of stem cell retention at 18 hours. Response to SCT was predefined as an increase in LVEF of ≥5% at 3 months. The majority (84%) of patients were male with an overall mean LVEF of 27 ± 7% and a median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of 2,774 pg/mL. Nineteen patients (51%) were responders to SCT. There was no significant difference between responders and nonresponders regarding to age, sex, baseline LVEF, NT-proBNP levels, or 6-minute walking distance. With the use of a partial least squares (PLS) predictive model, we identified 9 baseline factors that were associated with both stem cell response and stem cell retention (mechanistic validation). Among the baseline factors positively associated with both clinical response and stem cell retention were G-CSF, SDF-1, LIF, MCP-1, and MCP-3. Among baseline factors negatively associated with both clinical response and retention were IL-12p70, FASL, ICAM-1, and GGT. A decrease in G-CSF at 3-month follow-up was also observed in responders compared with nonresponders (P = .02).. If further validated, baseline immunologic and nonimmunologic biomarkers may help to identify patients with DCM who are more likely to respond to CD34(+)-based SCT.

Topics: Adult; Antigens, CD34; Biomarkers; Cardiomyopathy, Dilated; Chemokine CXCL12; Female; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Mobilization; Humans; Intercellular Adhesion Molecule-1; Leukemia Inhibitory Factor; Male; Middle Aged; Monitoring, Immunologic; Myocardial Perfusion Imaging; Peripheral Blood Stem Cell Transplantation; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Exametazime

A heart transplant patient treated with OKT3 developed a severe headache which worsened and was accompanied by a sudden decrease in the patient's consciousness level and aphasia when the treatment course was completed. CT was performed and was normal. SPET imaging with 99mTc-HMPAO of cerebral blood flow done 16 hours later revealed multiple and clear focal defects in the blood flow. Analysis of cerebral spinal fluid revealed aseptic pleocytosis. Five days after the completion of treatment, the symptoms remitted and a new control SPET 3 weeks later was completely normal. A diagnosis of neurotoxicity secondary to OKT3 administration was established.

Topics: Adult; Aphasia; Brain Abscess; Brain Edema; Cardiomyopathy, Dilated; Cerebral Hemorrhage; Cerebrospinal Fluid; Cerebrovascular Circulation; Confusion; Diagnosis, Differential; Headache; Heart Transplantation; Humans; Immunosuppressive Agents; Leukocytosis; Lymphocyte Activation; Male; Meningoencephalitis; Muromonab-CD3; Postoperative Complications; Radiopharmaceuticals; T-Lymphocytes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The effect of enalapril on cerebral blood flow (CBF) was studied in 11 patients with chronic heart failure (NYHA II or III, dilated cardiomyopathy in 6 and old myocardial infarction in 5). CBF was evaluated by analyzing the Patlak-Plot curve obtained from radionuclide angiography with technetium-99m hexamethylpropylene amine oxime (99mTC-HM-PAO). Cardiac index (CI) and stroke volume (SV) were simultaneously measured by impedance cardiography. These measurements were performed before and at four weeks after daily administration of 5 mg enalapril. The stroke volume, cardiac index, and heart rate were not significantly changed after four weeks of enalapril administration. However, CBF was increased by 6.5% from 36.72 +/- 4.66 to 39.13 +/- 5.65 mL/100g/min (P < 0.05). These results suggest that enalapril increased cerebral blood flow, which was not related to increased cardiac output in congestive heart failure. Patlak-Plot analysis of radionuclide angiography using 99mTC-HM-PAO may be available for quantitative assessment of brain perfusion.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Blood Flow Velocity; Cardiac Output; Cardiomyopathy, Dilated; Cerebrovascular Circulation; Chronic Disease; Enalapril; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Angiography; Stroke Volume; Technetium Tc 99m Exametazime

Forty-one children (15 girls, 26 boys; ages 3.0 +/- 2.1 years) with Kawasaki disease (KD) were included in our study. The diameters of a total of 82 coronary arteries (CA), comprising 41 left (LCA) and 41 right (RCA), were computed by two-dimensional echocardiography (2D-Echo). If the diameter of the CA was > or = 20 mm, it was considered as dilated. The severity of the carditis was evaluated by [99mTc]HMPAO-labeled white blood cell (WBC) heart scans (Tc-WBC) carried out in all cases. On the basis of the results the children were divided into three groups. Group A children had the most severe carditis where the heart uptake was greater than the bone uptake; 11 of 32 (34.3%) of the CA in 16 cases were dilated. Group B had carditis of medium severity where the heart uptake was equal to the bone uptake; 11 of 28 (39.3%) of the CA in 14 cases were dilated. Group C had mild carditis where the heart uptake was less than the bone uptake; 9 of 22 (40.9%) of the CA in 11 cases were dilated. There were no significant differences among the three groups (p = 0.87 by a chi-squared test). We conclude that no definite relationship exists between the severity of carditis and the dilatation of the CA in children with KD.

Topics: Cardiomyopathy, Dilated; Child, Preschool; Dilatation, Pathologic; Echocardiography; Female; Humans; Infant; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Severity of Illness Index; Technetium Tc 99m Exametazime

Topics: Cardiomyopathy, Dilated; Female; Humans; Infant; Leukocytes; Myocarditis; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime