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. 2014 Dec;103(6):521-9.
doi: 10.5935/abc.20140164. Epub 2014 Nov 4.

Autologous transplantation of bone marrow adult stem cells for the treatment of idiopathic dilated cardiomyopathy

[Article in English, Portuguese]
Ricardo João Westphal  1 , Ronaldo Rocha Loures Bueno  1 , Paulo Bezerra de Araújo Galvão  1 , José Zanis Neto  1 , Juliano Mendes Souza  1 , Ênio Eduardo Guérios  1 , Alexandra Cristina Senegaglia  1 , Paulo Roberto Brofman  2 , Ricardo Pasquini  1 , Claudio Leinig Pereira da Cunha  1
Affiliations

Autologous transplantation of bone marrow adult stem cells for the treatment of idiopathic dilated cardiomyopathy

[Article in English, Portuguese]
Ricardo João Westphal et al. Arq Bras Cardiol. 2014 Dec.

Abstract

Background: Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even under optimal medical treatment. Autologous infusion of bone marrow adult stem cells has shown promising preliminary results in these patients.

Objective: Determine the effectiveness of autologous transplantation of bone marrow adult stem cells on systolic and diastolic left ventricular function, and on the degree of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III.

Methods: We administered 4,54 x 10(8) ± 0,89 x 10(8) bone marrow adult stem cells into the coronary arteries of 24 patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Changes in functional class, systolic and diastolic left ventricular function and degree of mitral regurgitation were assessed after 3 months, 6 months and 1 year.

Results: During follow-up, six patients (25%) improved functional class and eight (33.3%) kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after 3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no significant changes neither in diastolic left ventricular function nor in mitral regurgitation degree. A combined cardiac resynchronization and implantable cardioversion defibrillation was implanted in two patients (8.3%). Four patients (16.6%) had sudden death and four patients died due to terminal cardiac failure. Average survival of these eight patients was 2.6 years.

Conclusion: Intracoronary infusion of bone marrow adult stem cells was associated with an improvement or stabilization of functional class and an improvement in left ventricular ejection fraction, suggesting the efficacy of this intervention. There were no significant changes neither in left ventricular diastolic function nor in the degree of mitral regurgitation.

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Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Modified Simpson’s method to calculate the ejection fraction of the left ventricle (A) Four-chamber view; (B) two-chamber view; on the left, diastole; on the right, systole.
Figure 2
Figure 2
Tissue Doppler with the sample volume positioned in the mitral valve ring plane, in the septal wall S: systolic wave; e': early diastolic wave; a': atrial systolic wave.
Figure 3
Figure 3
Modified Simpson's method to calculate to calculate the left atrial volume (A) Four-chamber view; (B) two-chamber view.
Figure 4
Figure 4
Method of calculating the myocardial performance index (IPM), or Tei index. ECG: electrocardiogram; TCI: isovolumetric contraction time; TRI: isovolumetric relaxation time; TE: ejection time.
Figure 5
Figure 5
Area of the regurgitant jet (ARJ) in relation to the area of the left atrium (ALA) in a case of significant mitral insufficiency (ARJ/ALA > 40%).
Figure 6
Figure 6
Kaplan-Meier survival curve for the sample studied
See this image and copyright information in PMC

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