― 143 ―The results suggest that CABG combined with iPS transplantation may be more effective in increasing myocardial blood flow in patients with low cardiac function and IHD. In the future, we plan to conduct an analysis of a large number of cases and investigate the characteristics of patients who benefit from CRT.はじめにCRT is a treatment option for patients with heart failure and reduced LVEF who exhibit severe symptoms despite optimal medical and invasive therapy. While HTx remains the only definitive curative treatment, many patients cannot be listed for HTx due to factors such as comorbid conditions or advanced age. CRT is expected as a promising alternative for patients who are ineligible for HTx and for whom ventricular assist device implantation is not feasible. NH3-PET has superior temporal and spatial resolution 1). NH3-PET enables the evaluation of MBF under resting conditions and during hyperemia induced by adenosine, as well as MFR, which represents the ratio of MBF during stress to that at rest. MFR serves as an index of cardiac circulation from the epicardial coronary arteries to the microvasculature. The integration of MFR with MPI enhances the diagnostic accuracy for IHD and facilitates more refined risk stratification when combined with data from coronary CT angiography 2, 3). Additionally, MFR is a significant prognostic indicator in individuals with various cardiac conditions, as a reduced MFR (<2.0) correlates with a poorer prognosis in both IHD and non-IHD cases 4).At our hospital, we initially performed CRT using autologous skeletal stem cell-sheet therapy, and in one case, we observed a transient improvement in MFR in the anteroseptal region of the LV following myocardial cell-sheet transplantation 5). However, as cell-sheet therapy failed to yield sustained therapeutic benefits, we have since adopted CRT using iPS cell-derived cardiac spheres transplantation for patients with IHD and severe LV dysfunction. Previous animal experiment has shown that the iPS cardiac spheres transplantation contributes to the improvement of cardiac function 6). However, no studies had examined the effects of iPS cardiac spheres transplantation in human. The current research whose protocol involves both iPS cell-derived cardiac spheres transplantation and CABG is ongoing. Although the improvement of MFR was show, the effect of CABG could not be excluded. Therefore, we compared the change of MFR measured by NH3-PET before and after surgery between iPS+CABG and only CABG.実験方法Between 2022 to 2023, patients with IHD scheduled for CABG, LVEF of 15-40%, and NYHA class II or higher were eligible. Patients who underwent NH3-PET before and after iPS cell-derived cardiac spheres transplantation and CABG were analyzed. We analyzed 16 patients that CABG alone was performed as a control group.The difference in MFR before and after surgery was defined as ΔMFR. PET parameters including ΔMFR, patient characteristics such as age, and comorbidities were compared. No statistical analysis was performed due to the small number of patients.
元のページ ../index.html#145