Effect of intracoronary transplantation of autologous bone marrow-derived mononuclear cells on outcomes of patients with refractory chronic heart failure secondary to ischemic cardiomyopathy.
Recent studies have indicated that stem cell implantation increases cardiac function by repairing damaged myocardium. We investigated whether intracoronary transplantation of autologous bone marrow-derived mononuclear cells (BMMCs) confers beneficial effects in patients with refractory chronic heart failure. Twenty-eight patients received standard heart failure medication and BMMC transplantation (BMMC treatment) or standard medication only (controls). BMMCs were harvested from each patient. Clinical manifestations, biochemical assays, rhythm studies, echocardiograms, and positron emission tomograms were recorded. Fourteen patients with cell grafting had symptomatic relief of heart failure within 3 days. Left ventricular ejection fraction increased by 9.2% and 10.5% at 1 week and 3 months after the procedure, respectively, versus baseline (p < 0.01 for the 2 comparisons). Left ventricular end-systolic volume decreased by 30.7% after 3 months (p < 0.01). Brain natriuretic peptide levels at days 3 and 7 after cell infusion significantly decreased by 69.2% and 70.4%, respectively, whereas atrial natriuretic peptide levels increased by 30.1% at day 7. Positron emission tomographic analysis showed a significant increase in cell viability of 10.3% in the infarcted zone. No patient died in the BMMC-treated group at 6-month follow-up. In contrast, heart failure did not improve in any control patient. Left ventricular ejection fraction decreased by 7.2% after 3 months. Two control patients died from heart failure within 6 months. In conclusion, this is the first demonstration in humans that intracoronary BMMC transplantation is a feasible and safe therapeutic strategy to decrease symptoms, increase cardiac function, and possibly prolong life in patients with end-stage heart failure refractory to standard medical therapy.
Gao
Lian Ru
LR
Department of Cardiology, Navy General Hospital, Beijing, People's Republic of China. lianru@yahoo.com.cn
Wang
Zhi Guo
ZG
Zhu
Zhi Ming
ZM
Fei
Yu Xing
YX
He
Sheng
S
Tian
Hai Tao
HT
Zhang
Ning Kun
NK
Chen
Yu
Y
Xu
Hong Tao
HT
Yang
Ye
Y
D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods*; D003331:Coronary Vessels; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000637:transplantation*; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D049268:Positron-Emission Tomography; D013318:Stroke Volume; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D020097:Natriuretic Peptide, Brain