2015


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2015/№1

Remote results of the cell therapy for ischemic heart disease complicated with heart failure

Chernyavsky A. M., Kliver E. N., Pokushalov E. A., Kliver E. E., Romanov A. B.
Federal State Budgetary Institution, "Academician E. N. Meshalkin Novosibirsk Research Institute of Circulatory Pathology" of the RF Ministry of Health Care, Rechkunovskaya 15, Novosibirsk 630055

Keywords: coronary heart disease, mononuclear fraction of autologous marrow cells, heart failure

DOI: 10.18087/rhj.2015.1.2036

Background. At present time, new medical technologies are being developed worldwide for treatment of IHD patients with severe HF. In recent years, experts have paid special attention to the cell therapy as a potentially promising therapeutic method. Aim. To evaluate immediate and remote outcomes in patients with pronounced ischemic myocardial dysfunction, who have received a therapy including transendocardiac implantation of a mononuclear fraction of autologous marrow cells (MFMC) with the use of NOGA navigation system. Materials and methods. Clinical and functional outcomes of the MFMC transendocardiac administration were analyzed in 55 patients with postinfarction cardiosclerosis and HF with LV EF <35 %. The NOGA system was used for introduction of 41±16×106 MFMCs on average to the MI border area. The fraction of CD34 / CD45 positive cells was 2.5±1.6 %. Results. At 12 and 36 months, the MFMC implantation resulted in improvements of angina FC from 2.7±0.1 to 1.9±0.2 and 2.2±0.2, respectively (р<0.05), and HF FC from 2.9±0.1 to 2.4±0.1 and 2.4±0.1, respectively (р<0.05), in the majority of patients. In the first year, LV EF statistically significantly increased from 25.4±0.7 % to 31.4±1.1 %. The 6‑min walk distance significantly increased from 215.7±11.1 m to 304.3±13.5 m, and this result remained at the achieved level for the next two years. In most cases, total indices of myocardial perfusion, which had been achieved earlier in the segments implanted with MFMCs by the 12‑month follow-up, remained at 36 months postoperative. At the stage of annual follow-up, the HF mortality was 14.5; 5.4 % of patients died of non-cardiac causes; and one patient had a surgery of orthotopic heart transplantation (1.8 %). In 3 years, 32.7 and 7.2 % of patients, respectively, died of HF and non-cardiac causes. Conclusion. Transendocardiac transplantation of MFMC is a safe intervention, which improves hemodynamic parameters and quality of life in a considerable proportion of IHD patients with severe HF.
  1. Tse HF, Kwong YL, Chan JK et al. Angiogenesis in ischemic myocardium by intramyocardial autologous bone marrow mononuclear cell implantation. Lancet. 2003 Jan 4;361 (9351:47–9.
  2. Fuchs S, Satler LF, Kornowski R et al. Catheter-based autologous bone marrow myocardial injection in no-option patients with advanced coronary artery disease: a feasibility study. J Am Coll Cardiol. 2003 May 21;41 (10):1721–4.
  3. Perin EC, Dohmann HF, Borojevic R et al. Transendocardial, auto­logous bone marrow cell transplantation for severe, chronic ischemic heart failure. Circulation. 2003 May 13;107 (18):2294–302.
  4. Perin EC, Dohmann HF, Borojevic R et al. Improved exercise capa­city and ischemia 6 and 12 months after transendocardial injection of autologous bone marrow mononuclear cells for ischemic cardiomyopathy. Circulation. 2004 Sep 14;110 (11 Suppl 1):II213–8.
  5. Beeres SL, Bax JJ, Dibbets P et al. Effect of intramyocardial injection of autologous bone marrow-derived mononuclear cells on perfusion, function, and viability in patients with drug-refractory chronic ischemia. J Nucl Med. 2006 Apr;47 (4):574–80.
  6. Perin EC, Silva GV, Sarmento-Leite R et al. Assessing myocardial viability and infarct transmurality with left ventricular electromechanical mapping in patients with stable coronary artery disease: validation by delayed-enhancement magnetic resonance imaging. Circulation. 2002 Aug 20;106 (8):957–61.
  7. Wrobleski D, Houghtaling C, Josephson ME et al. Use of electrogram characteristics during sinus rhythm to delineate the endocardial scar in a porcine model of healed myocardial infarction. J Cardiovasc Electrophysiol. 2003 May;14 (5):524–9.
  8. Marchlinski FE, Callans DJ, Gottlieb CD, Zado E. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic andnonischemic cardiomyopathy. Circulation. 2000 Mar 21;101 (11):1288–96.
  9. Ben-Haim SA, Osadchy D, Schuster I et al. Nonfluoroscopic, in vivo navigation and mapping technology. Nat Med. 1996 Dec;2 (12):1393–5.
  10. Gepstein L, Hayam G, Ben-Haim SA. A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results. Circulation. 1997 Mar 18;95 (6):1611–22.
  11. Berman DS, Hachamovitch R, Kiat H et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1995 Sep;26 (3):639–47.
  12. Liu Y, Guo J, Zhang P et al. Bone marrow mononuclear cell transplantation into heart elevates the expression of angiogenic factors. Microvasc Res. 2004 Nov;68 (3):156–60.
  13. Orlic D, Hill JM, Arai AE. Stem cells for myocardial regeneration. Circ Res. 2002 Dec;91 (12):1092–102.
  14. Silva GV, Perin EC, Dohmann HF et al. Catheter-based transendocardial delivery of autologous bone-marrow-derived mononuclear cells in patients listed for heart transplantation. Tex Heart Inst J. 2004;31 (3):214–9.
  15. Dohmann HF, Silva SA, Souza AL et al. Bone-marrow mononuclear cell therapy of severe ischemic heart failure. C R Biol. 2007 Jun-Jul;330 (6-7):543–9.
  16. Fuchs S, Satler LF, Kornowski R et al. Catheter-based autologous bone marrow myocardial injection in no-option patients with advanced coronary artery disease: a feasibility study. J Am Coll Cardiol. 2003 May 21;41 (10):1721–4.
  17. Fuchs S, Kornowski R, Weisz G et al. Safety and feasibility of transendocardial autologous bone-marrow cell transplantation in patients with advanced heart disease. Am J Cardiol. 2006 Mar 15;97 (6):823–9.
  18. Tse HF, Kwong YL, Chan JK et al. Angiogenesis in ischaemic myocardium by intramyocardial autologous bone marrow mononuclear cell implantation. Lancet. 2003 Jan 4;361 (9351):47–9.
Chernyavsky A. M., Kliver E. N., Pokushalov E. A. et al. Remote results of the cell therapy for ischemic heart disease complicated with heart failure. Russian Heart Journal. 2015;14 (1):19–24

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