Abstract 3498: Effect of Combined Delivery of Bone Marrow Mononuclear Stem Cells on the Myocardial Perfusion and Function in Diabetic Patients
Objectives. Cardiovascular risk factors such as diabetes mellitus (DM) are inversely correlated with the number and function of endothelial progenitor stem cells. In the present analysis of the MYSTAR prospective randomized study we have investigated the effect of DM on the outcome of cardiac stem cell therapy with autologous bone marrow mononuclear cells (BM-MNCs).
Methods. Patients with (n=18, 56±8y) or without DM (n=42, 51±11y) and with a left ventricular EF<45% after first AMI were randomized to early (32±12 days post-AMI) or late (93±15 days post-AMI) combined (intramyocardial followed by intracoronary delivery) treatment groups. The primary endpoints of the study were the changes in resting perfusion defect (infarct size, expressed in % of myocardium) and global EF measured by gated 99m-Tc-MIBI SPECT 3 months after the BM-MNCs therapy.
Results. Similar amount of BM was harvested in patients with or without DM, with the similar rate of CD34+ cells and cell viability. DM patients exhibited significantly larger baseline end-diastolic (EDV) and end-systolic volumes (ESV) post-MI (EDV: 232±76 vs 196±64 ml, p=0.021; ESV: 145±57 vs 123±50 ml, p=0.044) as compared with non-DM patients. The time between AMI and stem cell treatment was similar in both groups (65±37 vs 61±32 days post-MI in patients with or without DM). BM-MNCs therapy led to a moderate change in global EF in DM patients (from 36.4±5.2 to 38.9±7.1%, p=0.103) in contrast to non-DM patients (from 38.7±6.3 to 42.4±8.6% p=0.001). The infarct size decreased significantly only in patients without DM 3 months after stem cell delivery (from 27.8±12.5% to 26.3±12.2%, p=0.36 and from 26.9±10% to 23.2±10.9%, p=0.044 in DM and non-DM groups, resp.). Further subanalysis revealed that DM patients did not have benefit from late cardiac BM-MNCs therapy (EF: from 36.9±5.9% to 37.6±7%, infarct size: from 28.3±13.7% to 28.8±11.8%) in contrast with DM-patients with early treatment (EF: from 35.6±4.3% to 40.8±7.5% p=0.005, infarct size: from 27.4±11.4% to 22.7±15.1%, p=0.05)..
Conclusions. In contrast with non-DM patients, cardiac BM-MNCs therapy in DM patients with severely decreased LV function might be less effective after 3 months post-MI.