Abstract 2466: Effect of Combined (Intramyocardial and Intracoronary) Application of Autologous Stem Cells on Cardiac Remodeling in Chronic Heart Failure
Objectives. Myocardial and intracoronary bone marrow (BM) stem cell (SC) therapy has been proven to reduce stress and resting myocardial perfusion defect and improves global systolic left ventricular function. The aim of this study was to assess the effect of combined (intramyocardial and intracoronary) autologous stem cell therapy on cardiac remodeling in chronic heart failure.
Methods. Thirty-two no option patients (94% men, 55+/− 12 y) with congestive heart failure and left ventricular (LV) ejection fraction (EF) <40%, not amenable for conventional revascularization underwent combined, NOGA-guided intramyocardial (3.8+/−0.3 ml) and intracoronary (29+/−14 ml) autologous BM-SC therapy. The number of the injected nonselected BM-SCs were 382+/−199 million BM-CS (1.6+/−0.1% of CD34+ cells). The baseline and 6-month follow-up (FUP) clinical symptoms (NYHA, CCS), the LV systolic and diastolic function (by contrast ventriculography and echocardiography), the myocardial viability (NOGA endocardial mapping) and the stress-induced and resting perfusion defect size (99m-Tc-Sestamibi scintigraphy) were compared.
Results. At FUP, a marked increase in LV EF (from 36.5+/−8.0% to 43.0+/−10.4%, p<0.001) along with a significant (p<0.05) decrease in LV end-diastolic volume (from 240+/−57 to 223+/−60 ml), end-diastolic pressure (from 24.1+/−7.9 to 20.8+/−8.0 mmHg), end-diastolic diameter (from 57.9+/−5.2 to 54.9+/−4.6 mm) and diameter of the left atrium (from 46.6+/−6.9 to 44.0+/−8.1 mm). This improvement was accompanied by a decrease (p<0.01) in the heart rate (from 72.3+/−13.4 to ,67.7+/−12.6), CCS (from 2.4+/−1.1 to 1.3+/−0.6) and NYHA classification (from 2.5+/−0.8 to 1.5+/−0.7). Combined stem cell therapy also induced a reduction of stress-induced perfusion defect size (from 26.9+/−8.7 to 22.2+/−10.1% of the total myocardium, p<0.05), while a trend to decrease of resting defect size was measured. Myocardial viability of the treated area assessed by NOGA mapping improved significantly (from 7.7+/−2.8 to 8.6+/−2.3 mV).
Conclusion. Our results indicate that the combined stem cell therapy decreases the cardiac remodeling in patients with chronic heart failure improving the systolic and also the diastolic function of the heart.