Which Type of Stem Cells to Choose for Endocardial Injections in Ischemic Heart Failure Patients: Bone Marrow or Peripheral Blood?

Abstract

Introduction: Intramyocardial injection of autologous mononuclear stem cells is believed to be a promising method for the treatment of patients with chronic ischemic heart disease. Hypothesis: To compare the results of endocardial injections of the mononuclear stem cells derived from bone marrow (BMMC) or peripheral blood (PBMC) in patients with severe ischemic heart failure. Methods: In this study we included 52 ischemic heart failure patients (age 54 ± 7) with left ventricle ejection fraction (LVEF) ≤35% and III-IV NYHA and CCS functional classes without possibility for conventional revascularization. The patients of the first group (n=25) received endocardial injections of the BMMC using Noga system and the patients of the second group (n=27) received PBMC injections. The injections of both BMMC and PBMC were performed into the infarction border zone. There were no differences of baseline data between two groups. We analyzed all clinical data at 6 month of the follow-up period. Results: None of the periprocedural complications following BMMC and PBMC injections were observed. In the BMMC group we revealed improvement of CCS class (2.1 ± 0.6 vs 3.5 ± 0.5; p<0.05 vs. baseline) and NYHA functional class (2.3 ± 0.2 vs 3.4 ± 0.1; p<0.05 vs. baseline) at the moment of 6 month follow up. The same characteristics were observed in patients of the PBMC group. CCS and NYHA functional classes decreased from 3.3 ± 0.4 to 2.0 ± 0.4 and from 3.2 ± 0.4 to 2.2 ± 0.3 respectively (p<0.05 vs. baseline; NS between groups). LVEF increased in group BMMC (39 ± 2% vs 30 ± 3%; p<0.05 vs. baseline) as well as in the PBMC group (40 ± 2 % vs. 32 ± 2 %; p<0.05 vs. baseline; NS between groups). Summed rest and stress score improved in the BMMC group after 6 months (14.7 ± 5.8 vs. 22.5 ± 5.2 and 16.4 ± 4.2 vs. 25.2 ± 4.7 respectively; p<0.05 vs. baseline). Also there were the same data of the summed rest and stress score in the patients of the PBMC group (14.1 ± 5.2 vs. 20.9 ± 4.8 and 15.9 ± 3.9 vs. 24.8 ± 4.1 respectively; p<0.05 vs. baseline; NS between groups). Conclusion: There was no difference between BMMC and PBMC injections on clinical data. Endocardial injections of autologous mononuclear cells derived from bone marrow and peripheral blood in ischemic heart failure patients improves clinical symptoms and has beneficial effect on LV function.