title: Intramyocardial bone marrow mononuclear cell transplantation in ischemic heart failure: Long-term follow-up.
abstract: BACKGROUND
  Long-term results regarding treatment of chronic ischemic heart failure with bone marrow mononuclear cells (BMMCs) have been few. We received encouraging results at the 1-year follow-up of patients treated with combined coronary artery bypass grafting (CABG) and BMMCs, so we decided to extend the follow-up.
  
  
  METHODS
  The study patients had received injections of BMMCs or vehicle into the myocardial infarction border area during CABG in a randomized and double-blind manner. We could contact 36 of the 39 patients recruited for the original study. Pre-operatively and after an extended follow-up period, we performed magnetic resonance imaging, measured pro-B-type amino-terminal natriuretic peptide, reviewed patient records from the follow-up period, and determined current quality of life with the Medical Outcomes Study Short-Form 36 (SF-36) Health Survey.
  
  
  RESULTS
  The median follow-up time was 60.7 months (interquartile range [IQR], 45.1-72.6 months). No statistically significant difference was detected in change of pro-B-type amino-terminal natriuretic peptide values or in quality of life between groups. The median change in left ventricular ejection fraction was 4.9% (IQR, -2.1% to 12.3%) for controls and 3.9% (IQR, -5.2% to 10.2%) for the BMMC group (p = 0.647). Wall thickening in injected segments increased by a median of 17% (IQR, -5% to 30%) for controls and 15% (IQR, -12% to 19%) for BMMC patients (p = 0.434). Scar size in injected segments increased by a median of 2% (IQR, -7% to 19%) for controls but diminished for BMMC patients, with a median change of -17% (IQR, -30% to -6%; p = 0.011).
  
  
  CONCLUSIONS
  In the treatment of chronic ischemic heart failure, combining intramyocardial BMMC therapy with CABG fails to affect cardiac function but can sustainably reduce scar size, even in the long-term.
authors: Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital. Electronic address: miia.1.1ehtinen@helsinki.fi.
authors: Miia
authors: M
authors: Lehtinen
authors: Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital.
authors: Tommi
authors: T
authors: Pätilä
authors: Institute of Biomedicine, Pharmacology, University of Helsinki.
authors: Esko
authors: E
authors: Kankuri
authors: Division of Roentgenology, HUS Medical Imaging Center.
authors: Kirsi
authors: K
authors: Lauerma
authors: Department of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors: Juha
authors: J
authors: Sinisalo
authors: Department of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors: Mika
authors: M
authors: Laine
authors: Department of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors: Markku
authors: M
authors: Kupari
authors: Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital.
authors: Antti
authors: A
authors: Vento
authors: Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital; Institute of Biomedicine, Pharmacology, University of Helsinki.
authors: Ari
authors: A
authors: Harjula
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000637:transplantation*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D009206:Myocardium; D013997:Time Factors
keywords: bone marrow mononuclear cells; bypass surgery; heart failure; myocardial infarction