Transendocardial, autologous bone marrow cell transplantation for severe, chronic ischemic heart failure.
BACKGROUND
This study evaluated the hypothesis that transendocardial injections of autologous mononuclear bone marrow cells in patients with end-stage ischemic heart disease could safely promote neovascularization and improve perfusion and myocardial contractility.


RESULTS
Twenty-one patients were enrolled in this prospective, nonrandomized, open-label study (first 14 patients, treatment; last 7 patients, control). Baseline evaluations included complete clinical and laboratory evaluations, exercise stress (ramp treadmill), 2D Doppler echocardiogram, single-photon emission computed tomography perfusion scan, and 24-hour Holter monitoring. Bone marrow mononuclear cells were harvested, isolated, washed, and resuspended in saline for injection by NOGA catheter (15 injections of 0.2 cc). Electromechanical mapping was used to identify viable myocardium (unipolar voltage > or =6.9 mV) for treatment. Treated and control patients underwent 2-month noninvasive follow-up, and treated patients alone underwent a 4-month invasive follow-up according to standard protocols and with the same procedures used as at baseline. Patient population demographics and exercise test variables did not differ significantly between the treatment and control groups; only serum creatinine and brain natriuretic peptide levels varied in laboratory evaluations at follow-up, being relatively higher in control patients. At 2 months, there was a significant reduction in total reversible defect and improvement in global left ventricular function within the treatment group and between the treatment and control groups (P=0.02) on quantitative single-photon emission computed tomography analysis. At 4 months, there was improvement in ejection fraction from a baseline of 20% to 29% (P=0.003) and a reduction in end-systolic volume (P=0.03) in the treated patients. Electromechanical mapping revealed significant mechanical improvement of the injected segments (P<0.0005) at 4 months after treatment.


CONCLUSIONS
Thus, the present study demonstrates the relative safety of intramyocardial injections of bone marrow-derived stem cells in humans with severe heart failure and the potential for improving myocardial blood flow with associated enhancement of regional and global left ventricular function.
Perin
Emerson C
EC
Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex, USA. eperin@crescentb.net
Dohmann
Hans F R
HF
Borojevic
Radovan
R
Silva
Suzana A
SA
Sousa
Andre L S
AL
Mesquita
Claudio T
CT
Rossi
Maria I D
MI
Carvalho
Antonio C
AC
Dutra
Helio S
HS
Dohmann
Hans J F
HJ
Silva
Guilherme V
GV
Belém
Luciano
L
Vivacqua
Ricardo
R
Rangel
Fernando O D
FO
Esporcatte
Roberto
R
Geng
Yong J
YJ
Vaughn
William K
WK
Assad
Joao A R
JA
Mesquita
Evandro T
ET
Willerson
James T
JT
D016026:Bone Marrow Transplantation; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003326:Coronary Circulation; D004699:Endocardium; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000628:therapy*; D018919:Neovascularization, Physiologic; D033581:Stem Cell Transplantation / Q000009:adverse effects; D015899:Tomography, Emission-Computed, Single-Photon; D014182:Transplantation, Autologous; D016277:Ventricular Function, Left