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STATE-OF-THE-ART PAPER

Role of Imaging in Cardiac Stem Cell Therapy

Saskia L.M.A. Beeres, MD^_*, Frank M. Bengel, MD, Jozef Bartunek, MD, Douwe E. Atsma, MD^_*, Jonathan M. Hill, MD, Marc Vanderheyden, MD, Martin Penicka, MD^||, Martin J. Schalij, MD^_*, William Wijns, MD and Jeroen J. Bax, MD^_*,_*

^_* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Cardiovascular Center Aalst, Aalst, Belgium
Department of Cardiovascular Diseases, King's College, London, United Kingdom
^|| CardioCenter, 3rd Medical School, Charles University and University Hospital, Prague, Czech Republic

Manuscript received August 28, 2006; revised manuscript received October 11, 2006, accepted October 23, 2006.

^_* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, C5-P, Leiden University Medical Center, P.O. Box 9600, 2300RC Leiden, the Netherlands. (Email: jbax{at}knoware.nl).

Stem cell therapy has emerged as a potential therapeutic option for cell death-related heart diseases. Preclinical and a number of early phase human studies suggested that cell therapy may augment perfusion and increase myocardial contractility. The rapid translation into clinical trials has left many issues unresolved, and emphasizes the need for specific techniques to visualize the mechanisms involved. Furthermore, the clinical efficacy of cell therapy remains to be proven. Imaging allows for in vivo tracking of cells and can provide a better understanding in the evaluation of the functional effects of cell-based therapies. In this review, a summary of the most promising imaging techniques for cell tracking is provided. Among these are direct labeling of cells with super-paramagnetic agents, radionuclides, and the use of reporter genes for imaging of transplanted cells. In addition, a comprehensive summary is provided of the currently available studies investigating a cell therapy-related effect on left ventricular function, myocardial perfusion, scar tissue, and myocardial viability.

Abbreviations and Acronyms   CT = computed tomography   FDG = fluorodeoxyglucose   HMPAO = exametazime   LV = left ventricle/ventricular   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   MRI = magnetic resonance imaging   PET = positron emission tomography   SPECT = single-photon emission computed tomography

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