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Effect of Intracoronary Injection of Mononuclear Bone Marrow Stem Cells on Left Ventricular Function in Patients With Acute Myocardial Infarction

Published:September 28, 2009DOI:https://doi.org/10.1016/j.amjcard.2009.06.057
      To investigate the effect of intracoronary injection of autologous mononuclear bone marrow stem cells (BMSCs) in patients with ST-elevation myocardial infarction (STEMI) on left ventricular (LV) systolic and diastolic function using standard echocardiography and 2-dimensional systolic strain. A total of 60 patients with first anterior wall STEMI and LV ejection fraction of <40%, treated with successful primary percutaneous coronary intervention were randomly assigned to the treatment group (BMSC group) or the control group in a 2:1 ratio. Transcatheter intracoronary injection of BMSCs into the infarct-related artery was performed 7 days after STEMI. Standard echocardiography and speckle tracking analysis was performed at baseline and 6 months after STEMI. No differences were found in the baseline echocardiographic parameters of LV systolic and diastolic dysfunction—the LV ejection fraction was 35 ± 6% in the BMSC group, similar to that in the control group (33 ± 7%, p = 0.42). After 6 months, the absolute change in the LV ejection fraction was significantly greater in the BMSC group than in the control group (10 ± 9% versus 5 ± 8%, p = 0.04). Significant improvement was seen in 2-dimensional systolic strain in all segments (12 ± 4 vs 14 ± 4; p = 0.0009) and in the infarcted area (5 ± 2 vs 6 ± 2; p = 0.0038) only in the BMSC group. Of the diastolic function parameters, we observed improvement in the early filling propagation velocity (30 ± 8 cm/s vs 37 ± 13 cm/s; p = 0.0008), early diastolic velocity − E′ (4.5 ± 1.5 vs 5.0 ± 1.3, p = 0.02), and the E/E′ ratio (17 ± 7 vs 14 ± 5; p = 0.03) in the BMSC group. In conclusion, intracoronary injection of unselected BMSCs in patients with STEMI improved both LV systolic and diastolic function at 6 months of follow-up.
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      References

        • Guan K.
        • Hasenfuss G.
        Do stem cells in the heart truly differentiate into cardiomyocytes?.
        J Mol Cell Cardiol. 2007; 43: 377-387
        • Abdel-Latif A.
        • Bolli R.
        • Tleyjeh I.M.
        • Montori V.M.
        • Perin E.C.
        • Hornung C.A.
        • Zuba-Surma E.K.
        • Al-Mallah M.
        • Dawn B.
        Adult bone marrow-derived cells for cardiac repair: a systematic review and meta-analysis.
        Arch Intern Med. 2007; 167: 989-997
        • Lipinski M.J.
        • Biondi-Zoccai G.G.
        • Abbate A.
        • Khianey R.
        • Sheiban I.
        • Bartunek J.
        • Vanderheyden M.
        • Kim H.S.
        • Kang H.J.
        • Strauer B.E.
        • Vetrovec G.W.
        Impact of intracoronary cell therapy on left ventricular function in the setting of acute myocardial infarction: a collaborative systematic review and meta-analysis of controlled clinical trials.
        J Am Coll Cardiol. 2007; 50: 1761-1767
        • Janssens S.
        • Dubois C.
        • Bogaert J.
        • Theunissen K.
        • Deroose C.
        • Desmet W.
        • Kalantzi M.
        • Herbots L.
        • Sinnaeve P.
        • Dens J.
        • Maertens J.
        • Rademakers F.
        • Dymarkowski S.
        • Gheysens O.
        • Van Cleemput J.
        • Bormans G.
        • Nuyts J.
        • Belmans A.
        • Mortelmans L.
        • Boogaerts M.
        • Van de Werf F.
        Autologous bone marrow-derived stem-cell transfer in patients with ST-segment elevation myocardial infarction: double-blind, randomised controlled trial.
        Lancet. 2006; 367: 113-121
        • Bartunek J.
        • Vanderheyden M.
        • Vandekerckhove B.
        • Mansour S.
        • De Bruyne B.
        • De Bondt P.
        • Van Haute I.
        • Lootens N.
        • Heyndrickx G.
        • Wijns W.
        Intracoronary injection of CD133positive enriched bone marrow progenitor cells promotes cardiac recovery after recent myocardial infarction: feasibility and safety.
        Circulation. 2005; 112: I178-I183
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Picard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • Solomon S.D.
        • Spencer K.T.
        • Sutton M.S.
        • Stewart W.J.
        • Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines Standards Committee; European Association of Echocardiography
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Korycka A.
        • Plewka M.
        • Krawczynska A.
        • Zubkowicz M.
        • Wierzbowska A.
        • Wrzesien-Kus A.
        • Pluta A.
        • Krzeminska-Pakula M.
        • Robak T.
        The evaluation of efficacy of bone marrow CD34+ and CD133+ cells isolated from patients with acute myocardial infarction.
        Acta Haematol. 2008; 39: 73-86
        • Plewka M.
        • Krzemińska-Pakuła M.
        • Jeżewski T.
        • Wrzesien- Kus A.
        • Wierzbowska A.
        • Lipiec P.
        • Wierzbowska-Drabik K.
        • Peruga J.Z.
        • Korycka A.
        • Robak T.
        • Kasprzak J.D.
        Early echocardiographic assessment of coronary flow reserve after intracoronary administration of bone marrow stem cells in patients with myocardial infarction.
        Pol J Cardiol. 2008; 10: 48-53
        • Lipiec P.
        • Krzemińska-Pakuła M.
        • Plewka M.
        • Kuśmierek J.
        • Płachcińska A.
        • Szumiński R.
        • Robak T.
        • Korycka A.
        • Kasprzak J.D.
        Impact of intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction on left ventricular perfusion and function: a 6-month follow-up gated 99mTc-MIBI single-photon emission computed tomography study.
        Eur J Nucl Med Mol Imaging. 2009; 36: 587-593
        • Schächinger V.
        • Erbs S.
        • Elsässer A.
        • Haberbosch W.
        • Hambrecht R.
        • Hölschermann H.
        • Yu J.
        • Corti R.
        • Mathey D.G.
        • Hamm C.W.
        • Süselbeck T.
        • Assmus B.
        • Tonn T.
        • Dimmeler S.
        • Zeiher A.M.
        • REPAIR-AMI Investigators
        Intracoronary bone marrow-derived progenitor cells in acute myocardial infarction.
        N Engl J Med. 2006; 355: 1210-1221
        • Martin-Rendon E.
        • Brunskill S.J.
        • Hyde C.J.
        • Stanworth S.J.
        • Mathur A.
        • Watt S.M.
        Autologous bone marrow stem cells to treat acute myocardial infarction: a systematic review.
        Eur Heart J. 2008; 29: 1807-1818
        • Reisner S.A.
        • Lysyansky P.
        • Agmon Y.
        • Mutlak D.
        • Lessick J.
        • Friedman Z.
        Global longitudinal strain: a novel index of left ventricular systolic function.
        J Am Soc Echocardiogr. 2004; 17: 630-633
        • Leitman M.
        • Lysyansky P.
        • Sidenko S.
        • Shir V.
        • Peleg E.
        • Binenbaum M.
        • Kaluski E.
        • Krakover R.
        • Vered Z.
        Two-dimensional strain—a novel software for real-time quantitative echocardiographic assessment of myocardial function.
        J Am Soc Echocardiogr. 2004; 17: 1021-1029
        • Uznańska B.
        • Chrzanowski L.
        • Plewka M.
        • Lipiec P.
        • Krzemińska-Pakuła M.
        • Kasprzak J.D.
        The relationship between left ventricular late-systolic rotation and twist, and classic parameters of ventricular function and geometry.
        Kardiol Pol. 2008; 66: 740-747
        • Chrzanowski L.
        • Lipiec P.
        • Krzemińska-Pakuła M.
        • Wejner-Mik P.
        • Jasińska A.
        • Drozdz J.
        • Kasprzak J.D.
        Comparison of apical left ventricular segments strain imaging by tissue Doppler and speckle tracking echocardiography.
        Kardiol Pol. 2008; 66: 388-393
        • Herbots L.
        • D'Hooge J.
        • Eroglu E.
        • Thijs D.
        • Ganame J.
        • Claus P.
        • Dubois C.
        • Theunissen K.
        • Bogaert J.
        • Dens J.
        • Kalantzi M.
        • Dymarkowski S.
        • Bijnens B.
        • Belmans A.
        • Boogaerts M.
        • Sutherland G.
        • Van de Werf F.
        • Rademakers F.
        • Janssens S.
        Improved regional function after autologous bone marrow-derived stem cell transfer in patients with acute myocardial infarction: a randomized, double-blind strain rate imaging study.
        Eur Heart J. 2009; 30: 662-670
        • Schaefer A.
        • Meyer G.P.
        • Fuchs M.
        • Klein G.
        • Kaplan M.
        • Wollert K.C.
        • Drexler H.
        Impact of intracoronary bone marrow cell transfer on diastolic function in patients after acute myocardial infarction: results from the BOOST trial.
        Eur Heart J. 2006; 27: 929-935
        • Wierzbowska-Drabik K.
        • Drozdz J.
        • Plewka M.
        • et al.
        The utility of pulsed tissue Doppler parameters for the diagnosis of advanced left ventricular diastolic dysfunction.
        Echocardiography. 2006; 23: 189-196
        • Wierzbowska-Drabik K.
        • Krzemińska-Pakuła M.
        • Chrzanowski L.
        • Plewka M.
        • Waszyrowski T.
        • Drozdz J.
        • Kurpesa M.
        • Trzos E.
        • Kasprzak J.D.
        Age-dependency of classic and new parameters of diastolic function.
        Echocardiography. 2008; 25: 149-155
        • Wierzbowska-Drabik K.
        • Drozdz J.
        • Plewka M.
        • Kurpesa M.
        • Krzemińska-Pakula M.
        • Kasprzak J.D.
        Assessment of mitral inflow during standardized Valsalva maneuver in stratification of diastolic function.
        Echocardiography. 2007; 24: 464-471
        • Paulus W.J.
        • Tscho C.
        • Sanderson J.E.
        How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the heart failure and echocardiography associations of the European Society of Cardiology.
        Eur Heart J. 2007; 28: 2539-2550
        • Hillis G.S.
        • Møller J.E.
        • Pellikka P.A.
        • Gersh B.J.
        • Wright R.S.
        • Ommen S.R.
        • Reeder G.S.
        • Oh J.K.
        Noninvasive estimation of left ventricular filling pressure by E/e' is a powerful predictor of survival after acute myocardial infarction.
        J Am Coll Cardiol. 2004; 43: 360-367
        • Tendera M.
        • Wojakowski W.
        • Ruzyllo W.
        • Chojnowska L.
        • Kepka C.
        • Tracz W.
        • Musialek P.
        • Piwowarska W.
        • Nessler J.
        • Buszman P.
        • Grajek S.
        • Breborowicz P.
        • Majka M.
        • Ratajczak M.Z.
        • REGENT Investigators
        Intracoronary infusion of bone marrow-derived selected CD34+ CXCR4+ cells and non-selected mononuclear cells in patients with acute STEMI and reduced left ventricular ejection fraction: results of randomized, multicentre Myocardial Regeneration by Intracoronary Infusion of Selected Population of Stem Cells in Acute Myocardial Infarction (REGENT) trial.
        Eur Heart J. 2009; 30: 1313-1321