Selective Pressure-Regulated retroinfusion of fibroblast growth factor-2 into the coronary vein enhances regional myocardial blood flow and function in pigs with chronic myocardial ischemia
Georges von Degenfeld, MD*,
Philip Raake, MD*,
Christian Kupatt, MD*,
Corinna Lebherz, MD*,
Rabea Hinkel*,
Franz Josef Gildehaus, PhD ,
Wolfgang Münzing, PhD,
Andrea Kranz, PhD ,
Johannes Waltenberger, MD,
Marcus Simoes, MD ,
Markus Schwaiger, MD,
Eckart Thein, MD|| and
Peter Boekstegers, MD*,*
* Internal Medicine I, Grosshadern, Grosshadern University Hospital, Munich, Germany
Nuclear Medicine, Grosshadern University Hospital, Munich, Germany
Internal Medicine II, University Hospital, Ulm, Germany
Institute of Nuclear Medicine, Klinikum rechts der Isar, Munich, Germany
|| Institute of Surgical Research, Munich, Germany
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Figure 1 Induction of chronic myocardial ischemia using a reduction stent. (A) A stent graft is ligated in the center. (B) The stent is crimped on balloon and inflated at 14 atm; it remains unexpanded at the site of the ligature, resulting in an hourglass-shaped stenosis. (C) Postmortem angiogram at day 28. The arrow indicates the location of the reduction stent, which is totally occluded. Collaterals are visible connecting the proximal left anterior descending artery (LAD) and diagonal branches to the distal LAD.
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Figure 2 Regional perfusion map of the left ventricular after slicing from the basis to the apex. (A) Seven days after implantation (n = 7). Diamond line = rest; square line = adenosine. Continued on next page.
Figure 2 Continued
(B) Twenty-eight days after implantation (n = 7). Diamond line = rest; square line = adenosine. Adenosine = regional myocardial perfusion determined after intracoronary adenosine; LAD = left anterior descending artery; probe = number of transmural probes; rest = regional myocardial perfusion at rest.
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Figure 3 Polar map display of relative myocardial uptake of 18fluorodeoxyglucose (18FDG) and 13N-labeled ammonia (13NH3). The most basal LV wall segments are depicted in the most peripheral rings, whereas the most apical occupies the center of the map. S = septum; I = inferior; L = lateral; A = anterior. Segments with brighter colors (white, red) present higher uptake values. There is a large 13NH3 uptake defect in left anterior descending artery territory corresponding to 20% of the left ventricular. In the same area, increased uptake of 18FDG is observed.
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Figure 4 Tissue binding of 125iodine-labeled fibroblast growth factor-2 45 min after retroinfusion into the anterior cardiac vein (hashed bars, n = 3) or antegrade application into the left anterior descending artery (LAD) (black bars, n = 3). CX = circumflex artery.
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Figure 5 Regional transmural myocardial blood flow at day 28 in the left anterior descending artery (LAD) territory. Left panel = at rest; right panel = during pacing. Group A = controls; group B = retroinfusion of fibroblast growth factor-2; group C = antegrade delivery. *p < 0.05.
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Figure 6 Regional myocardial function at day 28. White bars (group A) = controls; black bars (group B) = retroinfusion of fibroblast growth factor-2; hashed bars (group C) = antegrade delivery. Top panel = proximal ischemic left anterior descending artery (LAD) territory; bottom panel = distal ischemic LAD territory.
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