Russian Heart Failure Journal 2011year Assessment of efficacy and comparison of two strategies of intracoronary infusion of bone marrow mononuclear cells (BMNC) to the circulation system of infarct-related coronary artery vs. non-infarct-related coronary artery in patients with postinfarction cardiosclerosis and chronic heart failure
Assessment of efficacy and comparison of two strategies of intracoronary infusion of bone marrow mononuclear cells (BMNC) to the circulation system of infarct-related coronary artery vs. non-infarct-related coronary artery in patients with postinfarction cardiosclerosis and chronic heart failure
Bazhan S. S., Sychev A. V., Mareev V. Yu., Samko A. N, Stukalova O. V., Saidova M. A., Shitov V. N., Samoilenko L. E., Sergienko V. B., Romanov Yu. A., Sokolov A. N., Belenkov Yu. N.
Keywords: intracoronary infusion, bone marrow mononuclear cells, postinfarction cardiosclerosis, CH
Relevance. If infarct-related artery (IRA) is not available for stem cell infusion, their transplantation in the circulation of non-infarct-related artery (NIRA) having collateral vessels with IRA can be one of the possible alternatives. Purpose. The comparison of two strategies of bone marrow mononuclear cells (BMNC) intracoronary infusion by their effects on the LV myocardium clinical functional status, remodeling parameters, contractility, and perfusion in patients with postinfarction myocardium changes and HF. Materials and methods. 24 patients with CHD, extensive postinfarction cardiosclerosis (PC), LVEF<40 %, NYHA I–II functional class CHF, without indication for additional NIRA revascularization, were randomized into two groups: сell-based therapy group (n=12) and reference group (n=12). To patients (n=6) of the сell-based therapy group, BMNCs were infused to the circulation system of the revascularized IRA – IRA cell group. To other сell-based therapy patients (n=6) with occluded IRA, BMNCs were injected to the NIRA circulation – NIRA cell group. Patients both with revascularized (n=6, IRA reference group) and non-revascularized IRA (n=6, NIRA reference group) were included to the reference group. Follow-up period was 6 months. Initially, in 3 and 6 months, LV myocardium clinical functional status, remodeling / perfusion scores were assessed. Results. In 3 and 6 months, IRA cell patients demonstrated increased initial 6‑minute walk distance. By the 6th month MRI results showed 5 % increase of LVEF (p<0.05). At the same time significant 5 % decrease of relative infarcted myocardium weight (p<0.05) and tendency to decrease of absolute infarcted myocardium weight by 7 g (р=0.059) were observed. NIRA cell patients showed statistically significant increase of 6‑minute walk distance in 3 months, but by the 6th month, this parameter did not differ much from the initial value. Tendency to 3 % LVEF increase (р=0.051), detected in 3 months, leveled by the 6th month of the follow-up period. Both reference groups demonstrated positive yet statistically insignificant dynamics of functional status, LVEF, no decrease of infarcted myocardium weight was observed. In none of the followed-up groups, significant changes of dysynergia and myocardium perfusion were detected, both in rest and against Dobutamine load. Thus, intracoronary BMNC infusion to the IRA circulation system in patients with PC and I–II class CHF is advantageous over the infusion to NIRA circulation.
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Bazhan S.S., Sychev A.V., Mareev V.Yu. et al. Assessment of efficacy and comparison of two strategies of intracoronary infusion of bone marrow mononuclear cells (BMNC) to the circulation system of infarct-related coronary artery vs. non-infarct-related coronary artery in patients with postinfarction cardiosclerosis and chronic heart failure. Russian Heart Failure Journal. 2011;12(6):319-325.