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


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2011/

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

DOI: 10.18087/ rhfj.2011.6.1616

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.
  1. Бажан С.C., Сычев А.В., Мареев В.Ю. и др. Изучение эффективности и безопасности интракоронарной трансплантации мононуклеарных клеток костного мозга в лечении пациентов с постинфарктными изменениями миокарда и сердечной недостаточностью. Журнал Сердечная Недостаточность. 2010;11 (3):139–147.
  2. Strauer BE, Brehm M, Zeus T et al. Repair of infarcted myocardium by autologous intracoronary mononuclear bone marrow cell transplantation in humans. Circulation. 2002;106 (15):1913–1918.
  3. Assmus B, Schachinger V, Teupe C et al. Transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction (TOPCARE-AMI). Circulation. 2002;106 (24):3009–3017.
  4. Bartunek J, Vanderheyden M, Vandekerckhove B et al. Intracoronary injection of CD133‑positive enriched bone marrow progenitor cells promotes cardiac recovery after recent myocardial infarction: feasibility and safety. Circulation. 2005;112 (9 Suppl):I178‑I183.
  5. Tendera M, Wojakowski W, Ruzyłło W et al. Intracoronary infusion of bone marrow-derived selected CD34+CXCR4+ cells and non-selected mononuclear cells in patients with acute STEMI and reduced left ventricular ejection fraction: results of randomized, multicentre Myocardial Regeneration by Intracoronary Infusion of Selected Population of Stem Cells in Acute Myocardial Infarction (REGENT) Trial. Eur Heart J. 2009;30 (11):1313–1321.
  6. Assmus B, Honold J, Schachinger V et al. Transcoronary transplantation of progenitor cells after myocardial infarction. N Engl J Med. 2006;355 (12):1222–1232.
  7. Erbs S, Linke A, Adams V et al. Transplantation of blood-derived progenitor cells after recanalization of chronic coronary artery occlusion: first randomized and placebo-controlled study. Circ Res. 2005;97 (8):756–762.
  8. Strauer BE, Brehm M, Zeus T et al. Regeneration of human infarcted heart muscle by intracoronary autologous bone marrow cell transplantation in chronic coronary artery disease: the IACT Study. J Am Coll Cardiol. 2005;46 (9):1651–1658.
  9. Yang ZJ, Ma DC, Wang W et al. Neovascularization and cardiomyocytes regeneration in acute myocardial infarction after bone marrow stromal cell transplantation: comparison of infarct-relative and noninfarct-relative arterial approaches in swine. Clin Chim Acta. 2007;381 (2):114–118.
  10. Gao LR, Wang ZG, Zhu ZM et al. Effect of intracoronary transplantation of autologous bone marrow-derived mononuclear cells on outcomes of patients with refractory chronic heart failure secondary to ischemic cardiomyopathy. Am J Cardiol. 2006;98 (5):597–602.
  11. Manginas A, Goussetis E, Koutelou M et al. Pilot study to evaluate the safety and feasibility of intracoronary CD133 (+) and CD133 (–) CD34 (+) cell therapy in patients with nonviable anterior myocardial infarction. Catheter Cardiovasc Interv. 2007;69 (6):773–781.
  12. Strauer BE, Yousef M, Schannwell CM. The acute and long-term effects of intracoronary Stem cell Transplantation in 191 patients with chronic heARt failure: the STAR-heart study. Eur J Heart Fail. 2010;12 (7):721–729.
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.

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