title: Repeated Intramyocardial Bone Marrow Cell Injection in Previously Responding Patients With Refractory Angina Again Improves Myocardial Perfusion, Anginal Complaints, and Quality of Life.
abstract: BACKGROUND
  Intramyocardial bone marrow cell injection is associated with improvements in myocardial perfusion and anginal symptoms in patients with refractory angina pectoris. This study evaluates the effect of repeated intramyocardial bone marrow cell injection in patients with residual or recurrent myocardial ischemia.
  
  
  RESULTS
  Twenty-three patients (17 men; 69±9 years) who had improved myocardial perfusion after the first injection but had residual or recurrent angina and ischemia on single-photon emission computed tomographic myocardial perfusion imaging were included. Patients again received intramyocardial injection of 100×10(6) autologous bone marrow mononuclear cells, 4.6±2.5 years after their first injection. No periprocedural complications occurred. Myocardial perfusion assessed using single-photon emission computed tomographic myocardial perfusion imaging improved from a summed stress score of 27.3±5.8 at baseline to 24.5±4.4 at 3 months (P=0.002) and 25.4±4.9 at 12 months of follow-up (P=0.002). Perfusion improvement after 3 months was comparable with the effect of the first injection (P=0.379). Anginal complaints improved ≤12 months after cell injection in Canadian Cardiovascular Society score (mean change at 3, 6, and 12 months: 0.6±0.9%, 0.5±0.9%, and 0.6±0.9%, respectively; Pslope=0.007, first versus repeated; P=0.188) and in quality of life score as measured by Seattle Angina Questionnaire (mean change at 3, 6, and 12 months: 7±14%, 8±14%, and 7±15%, respectively; Pslope=0.020, first versus repeated; P=0.126).
  
  
  CONCLUSIONS
  Repeated bone marrow cell injection in previously responding patients with refractory angina is associated with improvements in myocardial perfusion, anginal complaints, and quality of life score ≤12 months of follow-up.
  
  
  BACKGROUND
  URL: http://www.trialregister.nl. Unique identifier: NTR2664.
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Imke
authors.initials: I
authors.lastname: Mann
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Sander F
authors.initials: SF
authors.lastname: Rodrigo
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van Ramshorst
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Saskia L
authors.initials: SL
authors.lastname: Beeres
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Dibbets-Schneider
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: Wolterbeek
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Zwaginga
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Willem E
authors.initials: WE
authors.lastname: Fibbe
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: From the Departments of Cardiology (I.M., S.F.R., J.v.R., S.L.B., J.J.B., M.J.S., D.E.A.), Nuclear Medicine (P.D.-S.), Radiology (A.d.R.), Medical Statistics and Bioinformatics (R.W.), and Hematology (J.J.Z., W.E.F.), Leiden University Medical Center, Leiden, The Netherlands. D.E.Atsma@lumc.nl.
authors.forename: Douwe E
authors.initials: DE
authors.lastname: Atsma
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D001854:Bone Marrow Cells; D016026:Bone Marrow Transplantation; D006328:Cardiac Catheterization / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000628:therapy*; D055414:Myocardial Perfusion Imaging; D011788:Quality of Life / Q000523:psychology*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: angina pectoris; bone marrow; cell transplantation; ischemia; tomography, emission-computed, single-photon