title: Intramyocardial stem cell injection in patients with ischemic cardiomyopathy: functional recovery and reverse remodeling.
abstract: BACKGROUND
  Transcatheter, intramyocardial injections of bone marrow-derived cell therapy produces reverse remodeling in large animal models of ischemic cardiomyopathy.
  
  
  OBJECTIVE
  We used cardiac MRI (CMR) in patients with left ventricular (LV) dysfunction related to remote myocardial infarction (MI) to test the hypothesis that bone marrow progenitor cell injection causes functional recovery of scarred myocardium and reverse remodeling.
  
  
  RESULTS
  Eight patients (aged 57.2±13.3 years) received transendocardial, intramyocardial injection of autologous bone marrow progenitor cells (mononuclear or mesenchymal stem cells) in LV scar and border zone. All patients tolerated the procedure with no serious adverse events. CMR at 1 year demonstrated a decrease in end diastolic volume (208.7±20.4 versus 167.4±7.32 mL; P=0.03), a trend toward decreased end systolic volume (142.4±16.5 versus 107.6±7.4 mL; P=0.06), decreased infarct size (P<0.05), and improved regional LV function by peak Eulerian circumferential strain in the treated infarct zone (-8.1±1.0 versus -11.4±1.3; P=0.04). Improvements in regional function were evident at 3 months, whereas the changes in chamber dimensions were not significant until 6 months. Improved regional function in the infarct zone strongly correlated with reduction of end diastolic volume (r(2)=0.69, P=0.04) and end systolic volume (r(2)=0.83, P=0.01).
  
  
  CONCLUSIONS
  These data suggest that transcatheter, intramyocardial injections of autologous bone marrow progenitor cells improve regional contractility of a chronic myocardial scar, and these changes predict subsequent reverse remodeling. The findings support the potential clinical benefits of this new treatment strategy and ongoing randomized clinical trials.
authors.affiliation: Interdisciplinary Stem Cell Institute, Department of Medicine, University of Miami Miller School of Medicine, 1501 NW 10th Ave., Miami, FL 33136, USA.
authors.forename: Adam R
authors.initials: AR
authors.lastname: Williams
authors.forename: Barry
authors.initials: B
authors.lastname: Trachtenberg
authors.forename: Darcy L
authors.initials: DL
authors.lastname: Velazquez
authors.forename: Ian
authors.initials: I
authors.lastname: McNiece
authors.forename: Peter
authors.initials: P
authors.lastname: Altman
authors.forename: Didier
authors.initials: D
authors.lastname: Rouy
authors.forename: Adam M
authors.initials: AM
authors.lastname: Mendizabal
authors.forename: Pradip M
authors.initials: PM
authors.lastname: Pattany
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Lopera
authors.forename: Joel
authors.initials: J
authors.lastname: Fishman
authors.forename: Juan P
authors.initials: JP
authors.lastname: Zambrano
authors.forename: Alan W
authors.initials: AW
authors.lastname: Heldman
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Hare
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D007267:Injections; D008279:Magnetic Resonance Imaging; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000150:complications; D010865:Pilot Projects; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D020257:Ventricular Remodeling / Q000502:physiology*