First Evidence of Cardiac Stem Cells From the Left Ventricular Apical Tip in Patients With Left Ventricular Assist Device Implantation.
BACKGROUND
Recent studies have challenged the dogma that the adult heart is a postmitotic organ and raise the possibility of the existence of resident cardiac stem cells (CSCs). Our study aimed to explore if these CSCs are present in the "ventricular tip" obtained during left ventricular assist device (LVAD) implantation from patients with end-stage heart failure (HF) and the relationship with LV dysfunctional area extent.


METHODS
Four consecutive patients with ischemic cardiomyopathy and end-stage HF submitted to LVAD implantation were studied. The explanted "ventricular tip" was used as a sample of apical myocardial tissue for the pathological examination. Patients underwent clinical and echocardiographic examination, both standard transthoracic echocardiography (TTE) and speckle tracking echocardiography (STE), before LVAD implantation.


RESULTS
All patients presented severe apical dysfunction, with apical akinesis/diskinesis and very low levels of apical longitudinal strain (-3.5 ± 2.9%). Despite this, the presence of CSCs was demonstrated in pathological myocardial samples of "ventricular tip" in all 4 of the patients. It was found to be a mean of 6 c-kit cells in 10 fields magnification 40×.


CONCLUSIONS
Cardiac stem cells can be identified in the LV apical segment of patients who have undergone LVAD implantation despite LV apical fibrosis.
Department of Cardiovascular Diseases, University of Siena, Siena, Italy. Electronic address: matteo.cameli@yahoo.com.
M
M
Cameli
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
F M
FM
Righini
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
S
S
Sparla
Department of Pathological Anatomy, University of Siena, Siena, Italy.
D
D
Tacchini
Department of Cardiac Surgery, University of Siena, Siena, Italy.
A
A
Dokollari
Department of Cardiac Surgery, University of Siena, Siena, Italy.
C G
CG
Sassi
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
C
C
Di Tommaso
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
V
V
Curci
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
S
S
Censini
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
E
E
Incampo
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
F
F
Cassano
Department of Cardiac Surgery, University of Siena, Siena, Italy.
G
G
Droandi
Department of Cardiac Surgery, University of Siena, Siena, Italy.
S
S
Bernazzali
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
M
M
Focardi
Department of Life Sciences, University of Siena, Siena, Italy.
F
F
Ietta
Department of NeuroFarBa, Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata, University of Florence, Florence, Italy.
L
L
Sartiani
Department of Life Sciences, University of Siena, Siena, Italy.
R
R
Romagnoli
Department of Hematology, University of Siena, Siena, Italy.
G
G
Marotta
Department of NeuroFarBa, Centro Interuniversitario di Medicina Molecolare e Biofisica Applicata, University of Florence, Florence, Italy.
A
A
Mugelli
Department of Life Sciences, University of Siena, Siena, Italy.
L
L
Paulesu
Department of Cardiac Surgery, University of Siena, Siena, Italy.
G
G
Sani
Department of Pathological Anatomy, University of Siena, Siena, Italy.
P
P
Tanganelli
Department of Cardiac Surgery, University of Siena, Siena, Italy.
M
M
Maccherini
Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
S
S
Mondillo
D001706:Biopsy; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D005355:Fibrosis; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006352:Heart Ventricles / Q000166:cytology* / Q000000981:diagnostic imaging / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D009206:Myocardium / Q000166:cytology* / Q000473:pathology; D019919:Prosthesis Implantation; D013234:Stem Cells / Q000166:cytology*