title: Intracoronary administration of autologous bone marrow mononuclear cells after induction of short ischemia is safe and may improve hibernation and ischemia in patients with ischemic cardiomyopathy.
abstract: BACKGROUND
  Recent studies suggest that myocardial administration of stem cells improves perfusion and function of ischemic myocardium. The present study evaluated the safety and efficacy of simple intracoronary administration of mononuclear autologous bone marrow (BM) cells in patients with ischemic cardiomyopathy without revascularization option.
  
  
  RESULTS
  We enrolled 6 consecutive patients with ischemic cardiomyopathy, who were in New York Heart Association classes III to IV despite optimal medical treatment without revascularization options and who, on dobutamine stress echocardiograph (DSE), were found to have left ventricular ejection fraction < 35% with significant hibernation and ischemia in at least 2 myocardial segments. BM cell suspension was collected, and on the next day, during coronary angiography, mild ischemia was induced by a short balloon inflation in each coronary conduit with a TIMI flow of > or = 2 followed by slow infusion of up to 50 mL of BM cells suspension to each conduit. At baseline and 4 months' follow-up, patients underwent clinical evaluation, Holter monitoring, and DSE. BM infusion was successful in all patients. One patient developed postprocedure hypotension and troponin increase. At 4 months' follow-up New York Heart Association class improved from 3.5 +/- 0.5 to 2.3 +/- 1.0, P = .04, and resting ejection fraction improved from 25% +/- 7% to 28% +/- 8%, P = .055. We observed improvement in resting wall motion score only in the segments with hibernation in baseline DSE (2.3 +/- 0.5 to 2.0 +/- 0.6, P = .03) and improvement in high-dose dobutamine wall motion score, only in segments showing significant ischemia at baseline DSE (2.5 +/- 0.5 to 2.0 +/- 0.6, P = .001). There were no clinical arrhythmias or increased arrhythmia burden by Holter monitoring.
  
  
  CONCLUSIONS
  In patients with severe symptomatic ischemic cardiomyopathy, mild induction of ischemia followed by intracoronary infusion of unmanipulated autologous BM is feasible and safe and may improve hibernation and ischemia.
authors.affiliation: Cardiology Department, Assaf Harofeh Medical Center, The Sackler School of Medicine, Tel Aviv University, Israel. alexblatt@asaf.health.gov.il
authors.forename: Alex
authors.initials: A
authors.lastname: Blatt
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.forename: Marina
authors.initials: M
authors.lastname: Leitman
authors.forename: Ricardo
authors.initials: R
authors.lastname: Krakover
authors.forename: Edo
authors.initials: E
authors.lastname: Kaluski
authors.forename: Olga
authors.initials: O
authors.lastname: Milo-Cotter
authors.forename: Igor B
authors.initials: IB
authors.lastname: Resnick
authors.forename: Simcha
authors.initials: S
authors.lastname: Samuel
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.forename: Zvi
authors.initials: Z
authors.lastname: Vered
authors.forename: Shimon
authors.initials: S
authors.lastname: Slavin
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Shapira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016026:Bone Marrow Transplantation / Q000379:methods; D003331:Coronary Vessels; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy*