Electronic ISSN 2287-0237

VOLUME

MIDTERM RESULTS OF SURGICAL INTRAMYOCARDIAL IMPLANTATION OF AUTOLOGOUS ANGIOGENIC CELL PRECURSORS FOR CARDIOMYOPATHY

FEBRUARY 2017 - VOL.13 | ORIGINAL ARTICLE
OBJECTIVE

To report midterm results and assess clinical markers which can predict intramyocardial angiogenic cell precursors (ACPs) injection for cardiomyopathy outcomes.  

MATERIALS AND METHODS

Between May 2005 and April 2010, 143 consecutive cardiomyopathy patients underwent intramyocardial ACPs injection. Sixty patients were dilated cardiomyopathy (DCM) and 83 were ischemic cardiomyopathy (ICM). Mean age was 59.6 ± 12.1 years. ACPs were isolated from patient’s own blood and cultured. Number of cells prior to injection was 47.3 ± 36.8 million cells. ACPs were injected into non-viable myocardium and hypokinetic segments. Combined coronary artery surgery and cell injection were performed in 34.9% of ICM. Kaplan-Meier was used to estimate survival time. Cox proportional hazard model was applied by fitting data which included age, gender, diagnosis, diabetes, hypertension, hypercholesterolemia, pulmonary hypertension, renal failure, NYHA class, serum creatinine, preop LVEF, type of operations and number of ACPs into the model to identify predictors of death.

RESULTS

There was no new ventricular arrhythmia. Thirty-day mortality rate was 3.3% (2/60) for DCM and 8.4% (7/83) for ICM. Overall death rate was 14.5/1000/month (95%CI: 10.6-19.5). Overall survival probability at 12, 24, 36 and 48 months was 79.9% (95%CI: 72.1-85.8), 67.9% (95%CI: 58.5-75.6), 62.9% (95%CI: 52.4-71.7), 55.4% (95%CI: 43.0-66.2), respectively. LVEF improved by 3.6±12.3% (p = 0.04) for DCM and 7.6±10.1% (p < 0.001) for ICM. ICM patients with combined coronary artery surgery and cell injection showed more LVEF improvement. (11.8±11.6% vs 4.9 ± 8.0%, p = 0.007). Cox regression analyses suggested only preop LVEF (hazard ratio 0.91, 95% CI 0.87-0.95, p < 0.001) was associated with decreased survival. 

CONCLUSION

Intramyocardial ACPs injection improved LVEF in both DCM and ICM. Preop LVEF was a signifcant survival predictor.

MEDIA
Figure 1
New York Heart Association (NYHA) functional class: Preoperative and postoperative periods in dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM)
Figure 2
Boxplot of the left ventricular ejection fraction: before and after treatment in dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM). The lower and upper edges of the “box” are the frst and third quartile of the data (50% of the data lie within the box.). The “median” is shown as a line inside the box. The ends of the vertical lines or “whiskers” indicate minimum and maximum values, unless outliers are present in which case the whiskers extend to a maximum of 1.5 times the inter-quartile range. *represents outlier
Figure 3
Quality of life evaluated by the Short Form 36 at 3 months follow-up. A: Dilated cardiomyopathy (DCM), B: Ischemic cardiomyopathy (ICM) * represents p < 0.05
Figure 4
Survival curves for intramyocardial cell injection for cardiomyopathy calculated using the Kaplan-Meier method. A: Overall survival, B: LVEF less than 25% vs LVEF equal or more than 25%, C: DCM vs ICM, D: Cell injection alone vs OPCAB plus cell injection.
Figure 5
Comparative actuarial patient survival curves between cell injection to studies on other heart failure treatments [including medical treatments, implantable cardioverter defbrillator (ICD) implantation, surgical ventricular restoration (SVR), ventricular assisted devices (HeartMate and Novacor) and heart transplantation (Tx)].
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