Objective: The objective is to determine efficacy of intramyocardial angiogenic cell precursors (ACPs) injection in ischemic cardiomyopathy (ICM).
Methods: Twenty five ICM patients (cell group) underwent intramyocardial ACPs injection. Seventeen ICM patients (control group) from heart failure database treated by medical means were matched with cell group. There was no statistically significant different between cell and control groups in relation to preoperative left ventricular ejection fraction (LVEF) and co-morbidities. In the cell group, mean age was 58.4 ± 13.7 years. Mean LVEF was 26.2 ± 7.3%. NYHA Class was 2.9 ± 0.6. Fourteen underwent cell injection alone and 11 underwent combine Off-pump CABG (OPCAB) and cell injection. The ACPs were derived and expanded from autologous blood. The number of cells prior to injection was 27.4 ± 18.8 million cells. The cells were injected into the non-viable myocardium and hypokinetic segments in the cell group.
Results: There was no new ventricular arrhythmia. NYHA was improved by 0.9 ± 1.0 (P < 0.001) at 229.9 ± 98.8 days. Six-minute walk test improved in the cell group. The quality of life assessed by Short Form 36 demonstrated improving of role-physical, role-emotion, bodily pain and general health domains in the cell group. The LVEF was improved in 80% of patients (20/25). The LVEF improved by 9.3 ± 5.4 points % (P < 0.001) (from 25.0 ± 7.6% to 34.4 ± 10.9%) at 172.5 ± 121.1 days. The percentage of infarction area decreased 20.0 ± 16.2 points % at 5.4 ± 1.9 months postoperatively. There was no statistically different in changes of LVEF in the cell injection alone and combine OPCAB and cell injection (7 ± 4.7 vs. 6.3 ± 9.0 point %). There was also no statistically different in changes of LVEF in the cell group and control group (6.2 ± 7.1 vs. 3.2 ± 12.6 point %).
Conclusions: Intramyocardial ACPs injection is safe in the ICM patients. The quality of life was improved and area of infarction was reduced. The LVEF was significantly improved in the cell group. However the change of LVEF was not statistically different from the control group.