Background-Effective progenitor cell recruitment to the ischemic injury zone is a prerequisite for any potential therapeutic effect. Cell uptake determinants in humans with recent myocardial infarction are not defined. We tested the hypothesis that myocardial uptake of autologous CD34 + cells delivered via an intracoronary route after recent myocardial infarction is related to left ventricular (LV) ejection fraction (LVEF) and infarct size.Methods and Results-Thirty-one subjects (age, 36-69 years; 28 men) with primary percutaneous coronary interventiontreated anterior ST-segment-elevation myocardial infarction and significant myocardial injury (median peak troponin I, 138 ng/mL [limits, 58-356 ng/mL]) and sustained LVEF depression at ≤45% were recruited. On day 10 (days 7-12), 4.3×10 6 (0.7-9.9×10 6 ) 99m Tc-extametazime-labeled autologous bone marrow CD34 + cells (activity, MBq]) were administered transcoronarily (left anterior descending coronary artery).99m Tc-methoxyisobutyl isonitrile (99 m Tc-MIBI) single-photon emission computed tomography before cell delivery showed 7 (2-11) (of 17) segments with definitely abnormal/ absent perfusion. Late gadolinium-enhanced infarct core mass was 21.7 g (4.4-45.9 g), and infarct border zone mass was 29.8 g (3.9-60.2 g) (full-width at half-maximum, signal intensity thresholding algorithm). One hour after administration, 5.2% (1.7%-9.9%) of labeled cell activity localized in the myocardium (whole-body planar γ scan). Image fusion of labeled cell single-photon emission computed tomography with LV perfusion single-photon emission computed tomography or with cardiac magnetic resonance infarct imaging indicated cell uptake in the peri-infarct zone. Myocardial uptake of labeled cells activity correlated in particular with late gadolinium-enhanced infarct border zone mass (r=0.84, P<0.0001); it also correlated with peak TnI (r=0.76, P<0.001), severely-abnormal/absent perfusion segment number (r=0.45, P=0.008), and late gadolinium-enhanced infarct core (r=0.58, P=0.0003) but not with echocardiography LVEF (r=-0.07, P=0.68) or gated single-photon emission computed tomography LVEF (r=-0.28, P=0.16. The correlation with cardiac magnetic resonance imaging-LVEF was weak (r=−0.38; P=0.04). Conclusions-This largest human study with labeled bone marrow CD34+ cell transcoronary transplantation after recent STsegment-elevation myocardial infarction found that myocardial cell uptake is determined by infarct size rather than LVEF and occurs preferentially in the peri-infarct zone. (Circ Cardiovasc Imaging. 2013;6:320-328.) Key Words: cardiac magnetic resonance imaging ◼ CD34 + cells ◼ gadolinium late-enhancement ◼ infarct border zone ◼ myocardial infarction-cellular therapy ◼ progenitor cell tracking ◼ single-photon emission computed tomography ◼ transcoronary cell transplantation © 2012 American Heart Association, Inc. P rogenitor cell therapy is emerging as a promising therapeutic modality in patients with acute myocardial infarction (MI) and substantial myocardial injury, and over the la...

The extent of RVMI and RV dysfunction assessed early after STEMI are independent outcome predictors, which provide incremental prognostic value to clinical data, LV systolic function, and infarct burden. Measurement of RVEF may be particularly useful to stratify risk in patients with depressed LV function after STEMI.

• Multislice computed tomography enables detection and evaluation of the coronary artery anomalies. • Anomalous anatomy of the coronary artery potentially influences the prevalence of adverse events. • Adverse events tend to be most common in anomalous right coronary arteries.