Effect of intracoronary (IC) transplantation of autologous bone marrow-derived mesenchymal stem cells (BMSC) in patients with advanced left ventricular systolic dysfunction

Abstract

In the absence of cardiac transplantation programs and high cost of CRT-ICD in our community, large numbers of no-option HF patients (pts) for revascularization are still markedly symptomatic. IC-BMSC appears as promising option. 33 (27 males) with chronic HF, LVEF ⩽ 35 and mean age 46 y divided into 2 groups, 17 BMSC pts and 16 pts control. Both were maintained on maximum tolerated medications (follow-up 258 + 47 days). NYHA function class (NYHAFC), six minutes walking test (6MWT), LVESD, LVEDD, 2D-LVEF, systolic (S) and earlydiastolic (E) mitral annulus velocities by TDI evaluated. BMSC were obtained and selectively IC injected. Both groups showed improvement in NYHAFC from 3 to 2, P < 0.001 in BMSC, P < 0.04 for control. 6MWT marginally improved in BMSC from 348 ± 91 to 406 ± 87 meters (m) P < 0.06 while no improvement was noticed in control (361 ± 47 to 336 ± 110M, PNS). LVESD significantly decreased from 6.1 ± 0.8 to 5.7 ± 0.7 cm in BMSC, P < 0.028 while no changes occurred in the control group from 6.7 ± 1.0 to 6.6 ± 1.1 cm, PNS. No changes occurred in LVEDD from 7.1 ± 0.9 to 6.9 ± 0.7 cm in BMSC and from7.6 ± 1.1 to 7.56 ± 1.1 cm in control, PNS for both. No significant changes in LVEF occurred in control (26 ± 6 to 27 ± 7% PNS), while a trend for improvement occurred BMSC from 29 ± 6 to 33 ± 10%, P < 0.059. Mitral S wave showed trend for increase in MBSC (from 4.8 ± 1.5 to 5.3 ± 1.2 cm/s P < 0.058 while no changes occurred in control (5.2 ± 1.7 to 5.2 ± 1.5 cm/s). Mitral E wave showed non-significant increase from 5.7 ± 2.5 to 6.3 ± 2.6 cm/s in BMSC, non-significant decrease was noticed in control from 7.6 ± 2.4 to 7.1 ± 2.7 cm/s, PNS for both. There was no procedure related morbidity or mortality in the BMSC group. On top of standard and maximum tolerated medical treatment for chronic systolic HF, the addition of intracoronary autologous BMSC is feasible, safe and associated with subjective and objective functional improvement with trend towards improvement in parameters of LV performance.