title: Predictors of response to intramyocardial bone marrow cell treatment in patients with refractory angina and chronic myocardial ischemia.
abstract: BACKGROUND
  We previously showed that intramyocardial bone marrow cell (BMC) injection in patients with refractory angina and chronic myocardial ischemia improves myocardial perfusion, cardiac function and disease-related complaints. Treatment effect varied between patients, but the predictors of response remain to be identified. Therefore, the aim of the present study was to assess whether patient characteristics, procedural data and baseline measurements influence the response to intramyocardial BMC treatment in a large cohort of refractory angina patients.
  
  
  RESULTS
  In 120 patients (64 ± 9 years, 88% men) with refractory angina, 97 ± 13 × 10(6) BMCs were injected intramyocardially in regions with stress-inducible ischemia as assessed by single photon emission computed tomography (SPECT). Canadian Cardiovascular Society angina (CCS) class, quality-of-life score, exercise testing, SPECT and magnetic resonance imaging were performed at baseline and at 3 months follow-up demonstrating significant improvements in CCS class, quality-of-life, exercise capacity, myocardial perfusion and left ventricular function (all variables P<0.001). Multivariate analysis was performed to evaluate the influence of patient characteristics, procedural data and baseline measurements on BMC treatment response. Based on the improvement of myocardial perfusion at stress, diabetes and a large number of ischemic segments at baseline were shown to be independently associated with a large response to BMC therapy.
  
  
  CONCLUSIONS
  The present study demonstrates that diabetes and a large number of ischemic segments are predictors of a large response to intramyocardial BMC injection in refractory angina and chronic ischemia. Furthermore, the safety and efficacy results of previous trials are now confirmed in a larger study population.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Sander F
authors.initials: SF
authors.lastname: Rodrigo
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Ramshorst
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Imke
authors.initials: I
authors.lastname: Mann
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Darryl P
authors.initials: DP
authors.lastname: Leong
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Cannegieter
authors.affiliation: Department of Nuclear Medicine, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Imad
authors.initials: I
authors.lastname: Al Younis
authors.affiliation: Department of Nuclear Medicine, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Dibbets-Schneider
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.affiliation: Department of Immunohematology and Bloodtransfusion, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Willem E
authors.initials: WE
authors.lastname: Fibbe
authors.affiliation: Department of Immunohematology and Bloodtransfusion, Leiden University Medical Center, Leiden, The Netherlands; Jon J. van Rood Center for Clinical Transfusion Research, Sanquin, Leiden, The Netherlands.
authors.forename: Jaap Jan
authors.initials: JJ
authors.lastname: Zwaginga
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden,The Netherlands.
authors.forename: Saskia L
authors.initials: SL
authors.lastname: Beeres
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden,The Netherlands. Electronic address: d.e.atsma@lumc.nl.
authors.forename: Douwe E
authors.initials: DE
authors.lastname: Atsma
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D016026:Bone Marrow Transplantation / Q000379:methods*; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D016896:Treatment Outcome
keywords: Bone marrow cell; Cell therapy; Chronic ischemia; Intramyocardial injection