Abstract
To reduce long-term morbidity after revascularised acute myocardial infarction, different therapeutic strategies have been investigated. Cell therapy with mononuclear cells from bone marrow (BMMC) or peripheral blood (PBMC) has been proposed to attenuate the adverse processes of remodelling and subsequent heart failure. Previous trials have suggested that cell therapy may facilitate arrhythmogenesis. In the present substudy of the HEBE cell therapy trial, we investigated whether intracoronary cell therapy alters the prevalence of ventricular arrhythmias after 1 month or the rate of severe arrhythmogenic events (SAE) in the first year. In 164 patients of the trial we measured function and infarct size with cardiovascular magnetic resonance (CMR) imaging. Holter registration was performed after 1 month from which the number of triplets (3 successive PVCs) and ventricular tachycardias (VT, ≥4 successive PVCs) was assessed. Thirty-three patients (20%) showed triplets and/or VTs, with similar distribution amongst the groups (triplets: control n = 8 vs. BMMC n = 9, p = 1.00; vs. PBMC n = 10, p = 0.67. VT: control n = 9 vs. BMMC n = 9, p = 0.80; vs. PBMC n = 11, p = 0.69). SAE occurred in 2 patients in the PBMC group and 1 patient in the control group. In conclusion, intracoronary cell therapy is not associated with an increase in ventricular arrhythmias or SAE.
Highlights
The short-term mortality after acute myocardial infarction has decreased over the last decades, long-term morbidity remains high due to congestive heart failure caused by post-infarction remodelling [1,2,3]
More recent studies have suggested that certain subsets of mononuclear cells contribute to the repair by stimulating the production of new cardiomyocytes from endogenous progenitor cells [5]
The choice to discriminate between triplet PVCs and ventricular tachycardia was made in line with the results of the recently published MERLIN-TIMI 36 substudy
Summary
The short-term mortality after acute myocardial infarction has decreased over the last decades, long-term morbidity remains high due to congestive heart failure caused by post-infarction remodelling [1,2,3]. Between August 2005 and April 2008, the HEBE trial was conducted to assess the effect of intracoronary infusion with autologous mononuclear cells derived from either bone marrow (BMMCs) or peripheral blood (PBMCs), compared with standard therapy on recovery of regional and global left ventricular function after a revascularised acute myocardial infarction. To evaluate the safety of cell treatment, this substudy investigates the effect of intracoronary infusion of BMMCs or PBMCs after revascularised acute myocardial infarction on the prevalence of ventricular arrhythmias after 1 month and the occurrence of severe arrhythmogenic events (SAE) in the first year. Functional imaging was performed by using ECG-gated steady-state free precession cine imaging with breath-holding, for the acquisition of short-axis images covering the entire left ventricle (i.e. from base to apex) From these images, left ventricular volumes were measured and ejection fraction (LV EF) calculated [11]. Tests were performed using the Standard Package for the Social Sciences (SPSS 15.0)
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