Abstract 2432: Increase of Regional Metabolism in the Infarcted Zone and Cardiac Function After Intracoronary Transplantation of Autologous Bone Marrow Cells in Patients with Chronic Myocardial Infarction
Background: After myocardial infarction (MI) necrotic cardiomyocytes are irrecoverable and represents a major cause of infarct-related heart failure and death. In experimental infarction in animal models transplantation of bone marrow cells (BMCs) leads to regeneration of infarcted zones due to neovascularization and regeneration of myocardium. Both mechanisms have led to amelioration of cardiac function and perfusion. We assessed the hypothesis that intracoronary transplantation (i.c. TPx) of autologous, mononuclear BMCs may increase perfusion and metabolism in chronic ischemic heart disease after chronic infarcted myocardium in humans.
Methods: 25 patients (age 53 ± 12 year’s) received an i.c. transplantation of BMCs more than 6 months to 9 years after acute transmural MI. Transplantation was performed via the intracoronary administration route using 4 – 6 fractional infusions parallel to ballon inflation over 2– 4 min of 2–5 ml of cell suspension in the open infarct vessel with an average of 102 x 106 mononuclear cells. We conducted [F-18]FDG-PET and Tc-99m-Tetrofosmin SPECT before and 3 months after BMC transplantation. Myocardial glucose metabolism and perfusion were analyzed, using standardized, individually adjusted regions of interest (ROIs).
Results: The first PET scan demonstrated in all patients extended scars of the left ventricular myocardium. In the second scan three months later the normalized 18F-FDG uptake in the infarcted area had increased from 42 ± 8% to 50 ± 12% (p<0.05) and the mean number of scar regions decreased from 15 ± 7 to 12 ± 8 regions per patient (p< 0.05). These results were accompanied by improved global left ventricular ejection fraction (48±11 to 55±10%) (p<0.05). The perfusion of the infarct remained unchanged.
Conclusions: These results demonstrate that even in long standing myocardial scars an i.c. transplantation of BMCs leads to significant increase in cardiac function, regional metabolism in the infarcted zone as indication for BMC-induced myocardial regeneration and neovascularization. These changes are interpreted as partly revitalization of the infarcted tissue.