Improvement of exercise-induced cardiac deformation after cell therapy for severe chronic ischemic heart failure.
BACKGROUND
Intracoronary infusion of autologous bone marrow cells (CTX) has been shown to improve myocardial function in postinfarct patients and in patients with chronic ischemic cardiomyopathy. Whether CTX affects exercise-induced changes in cardiac deformation and mitral regurgitation (MR) in patients with end-stage heart failure has not been studied.


RESULTS
In this small pilot study, 11 patients with chronic ischemic cardiomyopathy, ejection fraction (EF) <25%, no inducible ischemia and heart failure class New York Heart Association (NYHA) III underwent CTX. Symptom-limited bicycle exercise echocardiography was performed pre- and 4 months post-CTX and maximum systolic strain (msyepsilon), peak systolic strain rate (psysr), and effective regurgitant orifice of MR (ERO) were determined. There were no complications related to the procedure. The overall clinical benefit of CTX was limited with a trend towards improvement (NYHA 3.0 +/- 0.1 pre- and 2.7 +/- 0.2 post-CTX, P = .06). The EF did not improve after CTX. The wall motion score index did not change at rest but decreased significantly during exercise (1.48 +/- 0.16 versus 1.44 +/- 0.17, P = .01). In patients with non-viable areas, msyepsilon, psysr, and ERO were not affected by CTX. However, in patients with viable areas, msyepsilon and psysr appeared to increase during exercise and ERO appeared to decrease from 19 +/- 5 to 16 +/- 5 mm(2). This effect was not apparent at rest and more pronounced with inferior viability.


CONCLUSIONS
CTX may improve cardiac deformation and MR during exercise in patients with severe chronic heart failure when viable areas are targeted.
Lebrun
Frederic
F
Division of Cardiology, Centre Hospitalier Luxembourg, Centre de Recherche Public Santé, 4 rue Barblé, L-1210 Luxembourg.
Berchem
Guy
G
Delagardelle
Charles
C
Beissel
Jean
J
Rouy
Didier
D
Wagner
Daniel R
DR
D016026:Bone Marrow Transplantation; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D014182:Transplantation, Autologous; D016896:Treatment Outcome