title: A double-blind, randomized, controlled, multicenter study to assess the safety and cardiovascular effects of skeletal myoblast implantation by catheter delivery in patients with chronic heart failure after myocardial infarction.
abstract: BACKGROUND
  We sought to determine the safety and preliminary efficacy of transcatheter intramyocardial administration of myoblasts in patients with heart failure (HF).
  
  
  METHODS
  MARVEL is a randomized placebo-controlled trial of image-guided, catheter-based intramyocardial injection of placebo or myoblasts (400 or 800 million) in patients with class II to IV HF and ejection fraction <35%. Primary end points were frequency of serious adverse events (safety) and changes in 6-minute walk test and Minnesota Living With HF score (efficacy). Of 330 patients intended for enrollment, 23 were randomized (MARVEL-1) before stopping the study for financial reasons.
  
  
  RESULTS
  At 6 months, similar numbers of events occurred in each group: 8 (placebo), 7 (low dose), and 8 (high dose), without deaths. Ventricular tachycardia responsive to amiodarone was more frequent in myoblast-treated patients: 1 (placebo), 3 (low dose), and 4 (high dose). A trend toward improvement in functional capacity was noted in myoblast-treated groups (Δ6-minute walk test of -3.6 vs +95.6 vs +85.5 m [placebo vs low dose vs high dose; P = .50]) without significant changes in Minnesota Living With HF scores.
  
  
  CONCLUSIONS
  In HF patients with chronic postinfarction cardiomyopathy, transcatheter administration of myoblasts in doses of 400 to 800 million cells is feasible and may lead to important clinical benefits. Ventricular tachycardia may be provoked by myoblast injection but appears to be a transient and treatable problem. A large-scale outcome trial of myoblast administration in HF patients with postinfarction cardiomyopathy is feasible and warranted.
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors: Thomas J
authors: TJ
authors: Povsic
authors: Christopher M
authors: CM
authors: O'Connor
authors: Timothy
authors: T
authors: Henry
authors: Andrew
authors: A
authors: Taussig
authors: Dean J
authors: DJ
authors: Kereiakes
authors: F David
authors: FD
authors: Fortuin
authors: Alan
authors: A
authors: Niederman
authors: Richard
authors: R
authors: Schatz
authors: Richard
authors: R
authors: Spencer
authors: Douglas
authors: D
authors: Owens
authors: Missy
authors: M
authors: Banks
authors: Diane
authors: D
authors: Joseph
authors: Rhonda
authors: R
authors: Roberts
authors: John H
authors: JH
authors: Alexander
authors: Warren
authors: W
authors: Sherman
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D032448:Myoblasts, Skeletal / Q000637:transplantation*; D009203:Myocardial Infarction / Q000150:complications