title: Percutaneous, transendocardial injection of bone marrow-derived mononuclear cells in heart failure patients following acute ST-elevation myocardial infarction: ALSTER-Stem Cell trial.
abstract: OBJECTIVE
  Patients with symptomatic heart failure following acute ST-elevation myocardial infarction (STEMI) received transendocardial application of bone marrow-derived mononuclear cells (BMC) to improve left ventricular (LV) function and clinical outcome.
  
  
  RESULTS
  Patients (n=12) with LV ejection fraction (EF) <45% and NYHA Class ≥II received NOGA-guided transendocardial injection of BMC into the infarction border zone 17.5±0.8 days following successful interventional revascularisation after STEMI. A matched control group (n=11) was generated from the source data of the previously published LIPSIAbciximab-STEMI trial. Primary and secondary endpoints were derived from comparisons of baseline vs. six-month follow-up cardiac magnetic resonance imaging (CMR) measurements and clinical assessments. Following cell therapy we observed a significant increase of EF (+7.9±1.5%, p=0.001) while the control group showed no change. This effect was driven by a reduction of LV end-systolic volume (ESV) by -27.5±6.5 ml (p=0.001); LV end-diastolic volume (EDV) and scar volu-me remained unchanged. A significant decrease of NYHA Class was found only in the cell therapy group (-0.75 vs. -0.18, p=0.04). Findings were also translated into enhancement of clinical assessments (rehospitalisation for decompensated heart failure, six-minute walk test, NT-proBNP levels).
  
  
  CONCLUSIONS
  The data suggest transendocardial injection of BMC can be used safely in patients with sympto-matic heart failure following acute STEMI. These prospective, preliminary data of a well-characterised, small cohort suggest efficiency compared to routine treatment.
authors.affiliation: Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: Christian-H
authors.initials: CH
authors.lastname: Heeger
authors.forename: Kai
authors.initials: K
authors.lastname: Jaquet
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.forename: Yanuar
authors.initials: Y
authors.lastname: Zulkarnaen
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cuneo
authors.forename: Dirk
authors.initials: D
authors.lastname: Haller
authors.forename: Dietmar
authors.initials: D
authors.lastname: Kivelitz
authors.forename: Tobias
authors.initials: T
authors.lastname: Schmidt
authors.forename: Korff
authors.initials: K
authors.lastname: Krause
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.forename: Carsten
authors.initials: C
authors.lastname: Schneider
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Martin W
authors.initials: MW
authors.lastname: Bergmann
mesh_terms: D000368:Aged; D016026:Bone Marrow Transplantation; D017023:Coronary Angiography; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015552:Injections, Intralesional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D056969:Voltage-Sensitive Dye Imaging