Intramyocardial Injection of Autologous Bone Marrow Mononuclear Cells in Patients With Chronic Myocardial Infarction and Severe Left Ventricular Dysfunction

doi:10.1016/j.amjcard.2007.04.056

The American Journal of Cardiology

Volume 100, Issue 7, 1 October 2007, Pages 1094-1098

https://doi.org/10.1016/j.amjcard.2007.04.056 Get rights and content

The present study investigated the safety, feasibility, and potential efficacy of autologous bone marrow cell injection in patients with chronic myocardial infarction and severe left ventricular (LV) dysfunction. In 15 patients (63 ± 9 years; 14 men) bone marrow was aspirated from the iliac crest. Using the NOGA system (Biosense-Webster, Waterloo, Belgium), 94 ± 14 × 10⁶ bone marrow–derived mononuclear cells were injected into the infarction border zone. Bone marrow cell injection was performed without periprocedural complications in all patients. At 2.5 months, 1 patient died from worsening heart failure. New York Heart Association class improved from 3.5 ± 0.5 at baseline to 2.7 ± 0.8 at 3 months (p <0.01) and 2.9 ± 0.8 at 6 months (p <0.01 vs baseline). LV ejection fraction (technetium-99m tetrofosmin single-photon emission computed tomography) increased from 23 ± 8% to 27 ± 9% at 3 months (p = 0.02) and regional wall thickening improved from 12.8 ± 5.9% to 15.3 ± 7.2% at 3 months (p = 0.02). Injected myocardial segments displayed a significant improvement in regional wall thickening (6.6 ± 6.3% vs 11.7 ± 7.0% at 3 months, p <0.01) and perfusion score (3.5 ± 0.7 vs 3.0 ± 0.9 at 3 months, p = 0.02) and a trend toward an improved fluorine-18 fluorodeoxyglucose score (2.9 ± 0.9 vs 2.6 ± 1.0 at 3 months, p = 0.06). Regional wall thickening (16.5 ± 8.9% vs 19.1 ± 9.1% at 3 months, p = NS), perfusion score (1.8 ± 0.4 vs 1.7 ± 0.5 at 3 months, p = NS), and fluorodeoxyglucose score (1.7 ± 0.4 vs 1.6 ± 0.4 at 3 months, p = NS) did not improve in noninjected myocardial segments. In conclusion, bone marrow cell injection in patients with chronic myocardial infarction and severe LV dysfunction is safe and feasible and appears to be associated with a decrease in heart failure symptoms and an improved LV function.

Section snippets

Patients

From February 2005 to April 2006, 15 patients were recruited into the study. Patients were eligible for inclusion if they had severe heart failure symptoms (New York Heart Association [NYHA] class III or IV) despite optimized medical therapy, a history of myocardial infarction (documented by typical symptoms, increased cardiac enzymes, and typical electrocardiographic changes) ≥12 months before enrollment, a fixed perfusion defect as demonstrated by technetium-99m (Tc-99m) tetrofosmin

Results

The study population consisted of 15 patients (mean age 63 ± 9 years, 14 men) with chronic myocardial infarction and severe LV dysfunction (Table 1). Patients had a history of myocardial infarction >12 months before enrollment and a fixed perfusion defect on Tc-99m tetrofosmin SPECT. All patients had severe heart failure symptoms despite optimized (if tolerated) medical therapy, including diuretics and oral anticoagulants in all, angiotensin-converting enzyme inhibitors in 93%, β blockers in

Discussion

The results of the present study demonstrate that intramyocardial bone marrow cell injection in patients with chronic myocardial infarction and severe LV dysfunction is safe and feasible in the short-term and midterm follow-up. In particular, the injection procedure was well tolerated and there were no periprocedural complications. Despite being a safety and feasibility study, the results of the present study also suggest that bone marrow cell injection in patients with chronic myocardial

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Yet, Kuethe F. et al. [29] did not find any improvement in LVEF in patients with large anterior infarcts treated with intracoronary aBM-MNC transplantation [29] To date, few researches focused on stem cell therapy in chronic myocardium infarction. Beeres et al. [9] found the therapy clinically safe and feasible, and was associated with a decrease in heart failure symptoms and an improved LV function. New York Heart Association (NYHA) class improved from 3.5 ± 0.5 at baseline to 2.9 ± 0.8 at 12 months (P < 0.01).
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Coronary artery diseaseIntramyocardial Injection of Autologous Bone Marrow Mononuclear Cells in Patients With Chronic Myocardial Infarction and Severe Left Ventricular Dysfunction

Section snippets

Patients

Results

Discussion

Am J Cardiol

J Am Coll Cardiol

Transendocardial, autologous bone marrow cell transplantation for severe, chronic ischemic heart failure

Circulation

Assessing myocardial viability and infarct transmurality with left ventricular electromechanical mapping in patients with stable coronary artery disease: validation by delayed-enhancement magnetic resonance imaging

Circulation

Effect of intramyocardial injection of autologous bone marrow-derived mononuclear cells on perfusion, function, and viability in patients with drug-refractory chronic ischemia

J Nucl Med

Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association

Circulation

Coronary artery disease
Intramyocardial Injection of Autologous Bone Marrow Mononuclear Cells in Patients With Chronic Myocardial Infarction and Severe Left Ventricular Dysfunction