ABSTRACT
BACKGROUND:Animal experiments have demonstrated that transplanted bone marrow stem cells (BMSCs)in the myocardial infarction region can directionally differentiate into myocardial cells with normal physiological function and promote neovascularization. Clinical studies have also showed that the cardiac function can be improved in myocardial infarction and cardiomyopathy patients after stem cell transplantation.OBJECTIVE: To observe the effect of autologous BMSCs transplantation on short-term cardiac function of patients with heart failure of ischemic cardiomyopathy.DESIGN: Self-control study.SETTING: Department of Cardiology, Xiangtan Central Hospital.PARTICIPANTS: Twenty-one patients with ischemic cardiomyopathy, including 13 males and 8 females, aged (64±6)years,who received treatment in the Department of Cardiology,Xiangtan Central Hospital of Hunan Province from March 2004 to January 2006 were retrieved. Inclusive criteria: with previous myocardial infarction at least once, B-mode ultrasonic cardiac examination showed that cardiac chamber was expanded, obvious cardiac inadequacy or stenocardia existed before stent implantation and hospitalized repeatedly, underwent percutaneous coronary artery intervention for restoring blood flow of infarcted vessel to TIMI3 degree over 3 months,but cardiac inadequacy existed to different degrees.Coronary arteriongraphy showed that no stenosis was found in the stent implanted in the coronary artery.Informed consents were obtained from all the patients.METHODS:After admission, all the patients received BMSCs transplantation based on routine drug treatment.Infarction-related arterial passage was established by percutaneous transluminal catheter technique and occluded by balloon.Isolated bone marrow stem cell suspension was injected into infarction-related arterial passage through the central cavity of catheter. ① Left ventricular ejection fractions (LVEF) and left ventricular end-diastolic diameter(LVDd)were measured before and 6 months after transplantation.② 24-hour dynamic electrocardiogram evaluation was conducted before and 6 months after transplantation under the precondition of not taking antiarrhythmic drugs. ③Clinical cardiac functional grading was conducted before and 6 months after transplantation by NYHA grading method: Grade Ⅰto Ⅳ: the higher grade, the severer symptom. ④ Adverse events and side effects were observed after operation.MAIN OUTCOME MEASURES:① LVEF and LVDd were measured before and 6 months after transplantation. ②24-hour dynamic electrocardiogram evaluation results. ③ Clinical cardiac functional grading evaluation results. ④ Post-operative adverse events and side effects.RESULTS:All the involved 21 patients participated in the result analysis.①The LVEF of patients 6 months after transplantation of BMSCs was more than that before transplantation [(54.4±6.2)％, (44.6±6.4)％,t = -5.946, P＜ 0.01], and LVDd of patients 6 months after transplantation was smaller than that before transplantation [(54.6±4.2), (60.2±4.4) mm,t = 5.306, P ＜ 0.01]. ② No new arrhythmic types appeared, and case of malignant serious cardiac arrhythmias were not increased. ③ Six months after transplantation of BMSCs, there were totally 9 patients with cardiac function of grade Ⅲ and Ⅳ, while there were 18 patients before transplantation. ④ The whole transplantation was safe.No patients were found to undergo re-examination of coronary arteriongraphy, which showed stent necrosis, due to chest pain, and no dead cases were either found.CONCLUSION:It is feasible to treat ischemic cardiomyopathy by percutaneous coronary transplantation of BMSCs,which can boost LVEF and improve cardiac function after transplantation.