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Randomized Controlled Trial
. 2015 Jul;34(7):899-905.
doi: 10.1016/j.healun.2015.01.989. Epub 2015 Feb 7.

Intramyocardial bone marrow mononuclear cell transplantation in ischemic heart failure: Long-term follow-up

Miia Lehtinen  1 , Tommi Pätilä  2 , Esko Kankuri  3 , Kirsi Lauerma  4 , Juha Sinisalo  5 , Mika Laine  5 , Markku Kupari  5 , Antti Vento  2 , Ari Harjula  6 ; Helsinki BMMC Collaboration
Collaborators, Affiliations
Randomized Controlled Trial

Intramyocardial bone marrow mononuclear cell transplantation in ischemic heart failure: Long-term follow-up

Miia Lehtinen et al. J Heart Lung Transplant. 2015 Jul.

Abstract

Background: Long-term results regarding treatment of chronic ischemic heart failure with bone marrow mononuclear cells (BMMCs) have been few. We received encouraging results at the 1-year follow-up of patients treated with combined coronary artery bypass grafting (CABG) and BMMCs, so we decided to extend the follow-up.

Methods: The study patients had received injections of BMMCs or vehicle into the myocardial infarction border area during CABG in a randomized and double-blind manner. We could contact 36 of the 39 patients recruited for the original study. Pre-operatively and after an extended follow-up period, we performed magnetic resonance imaging, measured pro-B-type amino-terminal natriuretic peptide, reviewed patient records from the follow-up period, and determined current quality of life with the Medical Outcomes Study Short-Form 36 (SF-36) Health Survey.

Results: The median follow-up time was 60.7 months (interquartile range [IQR], 45.1-72.6 months). No statistically significant difference was detected in change of pro-B-type amino-terminal natriuretic peptide values or in quality of life between groups. The median change in left ventricular ejection fraction was 4.9% (IQR, -2.1% to 12.3%) for controls and 3.9% (IQR, -5.2% to 10.2%) for the BMMC group (p = 0.647). Wall thickening in injected segments increased by a median of 17% (IQR, -5% to 30%) for controls and 15% (IQR, -12% to 19%) for BMMC patients (p = 0.434). Scar size in injected segments increased by a median of 2% (IQR, -7% to 19%) for controls but diminished for BMMC patients, with a median change of -17% (IQR, -30% to -6%; p = 0.011).

Conclusions: In the treatment of chronic ischemic heart failure, combining intramyocardial BMMC therapy with CABG fails to affect cardiac function but can sustainably reduce scar size, even in the long-term.

Keywords: bone marrow mononuclear cells; bypass surgery; heart failure; myocardial infarction.

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