Article Outline

Background

Methods

Results

Conclusions

Background

This study investigated whether PRST transplantation of ABMMC into the ischemic myocardium in patients with severe RA could safely reduce angina symptoms, improve myocardial perfusion, and increase left ventricular ejection fraction (LVEF).

Methods

A total of 26 patients were recruited from May 2005 to October 2006. Twelve were suitable for evaluation. Among evaluable patients, median follow-up was 16 months (range 7–20), median age was 68 years old (range 42–81), male/female ratio was 10:2, all of them with RA and ischemic stress-induced myocardial segments assessed by gated single-photon emission computed tomography (SPECT). Median volume of 303 ml (range 210–560) of bone marrow was obtained from iliac puncture under local anesthesia. Leukoconcentration was performed using HES 6% and refrigerate centrifugation under sterile conditions. Concentrated cells were implanted retrogradely by coronariography of the venous sinus and in selected veins previous occlusion of the balloon “over wire” for 8 to 10 min. Median number of mononuclear and CD34+ cells infused was 7.88×10⁸ and 1.206×10⁷, respectively, in a median volume of 45 ml (range 40–100). Angina symptoms, Canadian Cardiovascular Society class (CCS), myocardial perfusion, rest, and stress LVEF by SPECT were assessed at baseline and last follow-up.

Results

During and after the procedure, no arrhythmias or increase in enzymes or hemodynamic changes were observed. After a median time of 21 days, the ABMMC transplantation led to significant relief of angina symptoms and improvement in functional class. One patient died because of liver disease due to a HVC chronic infection not related to the procedure after 8 months. All but one evaluable patients improved CCS class by 1 (t=5, P<.001) when compared at baseline and last follow-up. By SPECT, we evaluated ischemic myocardium percentage; median baseline was 38.2% (range 17.6–76.5) and at last follow-up this was reduced to 26.5% (range 5.9–52.9) with statistically significant difference (t=4.082, P=.002). Rest LVEF by SPECT did not show statistical improvement between baseline (median 31.6%, range 15.8–74) and last follow-up (median 34.8%, range 24.6–67, t=2.041, P=.066), while stress LVEF does show statistical improvement between baseline (median 31.8%, range 15.5–67) and last follow-up (median 38.6%, range 26–68, t=4.596, P=.001). The median number of ischemic myocardium segments by SPECT was reduced from a baseline of 6.5 (range 3–13) to 4.5 (range 1–9) with statistically significant difference (t=4.08, P=.002).

Conclusions

Unselected ABMMC transplantation by PRST is safe, and it allows to infuse a large volume of cells in poorly irrigated coronary vessels. This study suggests improvement and potential outcome durability of angina symptoms relief and better functional class, myocardial perfusion, and contractility with this therapeutic approach in chronic coronary patients.

(A) Study of myocardial perfusion at baseline and at 6-month follow-up of BMC that comparatively shows improvement of the perfusion in the lateral view. (B) Study of myocardial perfusion at 6-month and 1-year follow-up of BMC that comparatively shows continues improvement of the perfusion in the lateral view.

(A,B) SPECT of myocardial perfusion at baseline and at 6-month follow-up of BMC transplantation that comparatively shows improvement of the perfusion in the septal and inferior views and an important increase of perfusion in the anterior view planes middle and basal.