Effect of transplantation of cord blood total nucleated cells on the manifestation and prognosis of refractory congestive heart failure

Abstract

The results of a prospective non-randomized observation study without control group to assess the course of heart failure in patients who underwent of cord blood total nucleated cells (CB TNCs) transplantation combined with traditional drug therapy have been presented.
 Materials. The study included 20 patients with congestive heart failure (CHF) IIA-IIB stage, functional class III-IV by the NYHA. CB TNCs transplantation was performed by a single intravenous dose of cell product "Cryopreserved human cord blood". Before and 1, 3, 6 and 9 months after CB TNC transplantation patients underwent echocardiographic study, the results of tests with the 6-minute walk determined exercise tolerance. The concentration of brain natriuretic peptide precursor (NT-proBNP) in blood was determined. The cardiovascular death risk was calculated using the scale MAGGIC.
 Results. Initial patients’ status was characterized by the presence of severe heart failure with reduced contractility of the myocardium and increased risk of 1- and 3-year death. Traditional conservative therapy (beta blockers, ACE inhibitors, diuretics) was not effective. After CB TNC transplantation there was registered a significant improvement of general condition of patients, an increase in exercise tolerance and, therefore, reduce of HF functional class by NYHA (before transplantation average FC was 3.2, in the post-transplant period – from 2.1 to 2, 8). Also after TNCs transplantation levels of biochemical markers of HF significantly decreased (before CB TNCs transplantation the level of NT-proBNP was 2370.3 ± 448.9 pg/mL, after CB TNCs transplantation – from 1198,6 ± 396,3 to 2300,7 ± 403,0 pg/mL ) and the same was estimated death risk from HF (1-year – 10.1-37.4 %, 3 years - 9.1-42.3 % relative to the data of the initial state). Reduced HF manifestations after CB TNCs transplantation allowed to reduce significantly the diuretics dose.
 Conclusion. Thus, transplantation of cord blood total nucleated cells in complex treatment of congestive heart failure has led to a greater efficiency of therapy and a significant reduce of CHF manifestations in patients.