Changes in left ventricular filling patterns after repeated injection of autologous bone marrow cells in heart failure patients.
OBJECTIVE
We have previously shown that repeated intracoronary infusion of bone marrow cells (BMSC) did not improve left ventricular (LV) ejection fraction in patients with chronic ischemic heart failure. However, the impact of BMSC therapy on LV diastolic filling has remained uncertain.


METHODS
Thirty two patients with LV ejection fraction less than 40% were studied. Each patient underwent three baseline echocardiograms to ensure stable LV filling. Infusion of BMSC was given at baseline and again after four months. Echocardiograms were repeated four, eight and 12 months after the first intervention. Main outcome measures were the ratio of transmitral flow (E) velocity to early mitral annulus (e') velocity (E/e'), left atrial (LA) volume and plasma levels of N-terminal pro-brain natriuretic peptide (NT-pro-BNP).


RESULTS
During the initial observational period there were no changes in main outcome. After treatment with intracoronary BMSC a significant decrease was observed in E/e' ratio (14.7+/-6.7 vs. 13.2+/-7.7, p=0.04), LA volume (90+/-25 ml vs. 80+/-26 ml, p=0.006) and plasma NT-pro-BNP (p=0.03). The effect was greatest in patients who received the largest amount of CD34(+) cells.


CONCLUSIONS
In this non-randomised study repeated intracoronary BMSC infusions had a beneficial effect on LV filling in patients with chronic ischemic heart failure. Randomised studies are warranted.
Department of Cardiology, Odense University Hospital, Denmark. a.diederichsen@dadlnet.dk
Axel C P
AC
Diederichsen
Jacob E
JE
Møller
Per
P
Thayssen
Lars
L
Videbaek
Susanne G
SG
Saekmose
Torben
T
Barington
Moustapha
M
Kassem
D000368:Aged; D015415:Biomarkers / Q000097:blood; D016026:Bone Marrow Transplantation; D003718:Denmark; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D020127:Recovery of Function; D033581:Stem Cell Transplantation; D013318:Stroke Volume; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain