Electronic ISSN 2287-0237

VOLUME

SAFETY AND EFFICACY OF INTRAMYOCARDIAL IMPLANTATION OF PERIPHERAL BLOOD STEM CELL FOR CARDIOMYOPATHY

SEPTEMBER 2011 - VOL.2 | ORIGINAL ARTICLE
OBJECTIVE

To determine the safety and efficacy of intramyocardial autologous blood stem cell injection for cardiomyopathy.

MATERIALS AND METHODS

Between May 2005 and February 2010, 126 consecutive patients underwent intramyocardial cell injection. Fifty two were dilated cardiomyopathy (DCM) and 74 were ischemic cardiomyopathy (ICM). Mean age was 59.2 ± 12.4 years. The stem cells are isolated from the patient’s own blood and cultured. The final product is called angiogenic cell precursors (ACPs). The number of cells prior to injection was 46.1 ± 36.5 million cells. ACPs were injected into all areas of the left ventricle in DCM patients, and into the non-viable myocardium and hypokinetic segments in ICM patients. Combined coronary artery surgery and cell injection were performed in 33.8% of ICM cases.

RESULTS

There was no new ventricular arrhythmia. The 30-day mortality rate was 3.8% (2/52) and 4.1% (3/74) in DCM and ICM, respectively. New York Heart Association (NYHA) class improved from 3.0 ± 0.6 to 2.0 ± 0.9 at 485.8 ± 370.3 days (p < 0.001) in DCM and improved from 2.7 ± 0.6 to 1.9 ± 0.8 at 419.6 ± 345.5 days (p < 0.001) in ICM. Left ventricular ejection fraction (LVEF) increased from 23.3 ± 7.0% to 27.7 ± 11.3% at 409.7 ± 352.4 days (p = 0.03) in DCM and increased from 23.6 ± 7.7% to 31.5 ± 10.0% at 400.6 ± 350.1 days (p < 0.001) in ICM. Quality of life evaluated at 3 months has significantly improved for physical function, rolephysical, general health and vitality domains in DCM. For ICM, physical function, role-physical, general health and social function domains were also improved.

CONCLUSION

Intramyocardial ACPs injection is feasible and safe in both DCM and ICM. NYHA, quality of life and LVEF had significantly improved in both DCM and ICM.

Keywords

Stem cells, Cell transplantation, Cardiomyopathy, Heart failure, Coronary artery bypass grafting

MEDIA
Table 1. The clinical characteristics of patients.
Figure 1: In Vitro Characteristics of angiogenic cell precursors (ACPs).
A. Photomicrographs illustrating the typical elongated, spindle-shaped morphology of cultured ACPs. B. The angiogenic potential of ACPs indicated by organization into tube-like structures (arrows).
Figure 2 : New York Heart Association (NYHA) functional class: Preoperative and postoperative periods in dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM).
Figure 3 : Boxplot of the left ventricular ejection fraction: before (pre) and after (post) treatment in dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM).
The lower and upper edges of the “box” demonstrate the first 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 the 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, LVEF = left ventricular ejection fraction.
Table 2. Preoperative and postoperative cardiac MRI (CMR) results in ischemic cardiomyopathy (IMC) patients.
Figure 4: Cardiac magnetic resonance imaging with gadolinium contrast;
Pre: infarction seen as a bright signal (arrows) at the left ventricular anterior and lateral walls, before stem cell transplant. Left ventricular ejection fraction was 13.2% with end-diastolic volume of 296 ml. Post: 3 months after stem cell transplant, there was no myocardial scar and ejection fraction was 20% with end-diastolic volume of 268 ml.
Figure 5: Quality of life evaluated by the Short Form 36 at 3 months follow-up.
a. Dilated cardiomyopathy (DCM). b. Ischemic cardiomyopathy (ICM). * p value < 0.05
SEARCH VOLUME & NUMBER
GO
RECENT VOLUME & NUMBER