Permyos Ruengsakulrach, MD, PhD, Kitipan V. Arom, MD, PhD, Vitoon Pitiguagool, MD.
Bangkok Heart Hospital, Bangkok, Thailand.
OBJECTIVE: The objective is to determine efficacy of intramyocardial angiogenic cell precursors (ACPs) injection for ischemic cardiomyopathy.
METHODS: Twenty five consecutive patients underwent ACPs injection (cell group). Seventeen, previously revascularization, had ACPs injection alone via microthoracotomy and eight had combine OPCAB plus ACPs injection. These are homogeneous group as shown in previous study. Another 25 who underwent OPCAB alone were served as a control group. There was no significantly different in preoperative co-morbidity and LVEF except that NYHA was higher in the cell group. Mean age was 63 ± 9.7 years. ACPs are isolated and cultured from the patient’s own blood. ACPs expressed CD34, CD133, KDR, Tie-2, CD144, von Willebrand factor, CD31Bright, concomitant binding of Ulex-Lectin and uptake of acetylated low density lipoprotein (Ac-LDL), secreted interleukin-8, vascular endothelial growth factor and angiogenin were injected into the non-viable myocardium and hypokinetic segments in the cell group. Number of cells was 25.3 ± 19.3 million cells with 94.3 ± 4.8% cell viability. Cells were injected into non-viable myocardium and hypokinetic segments.
RESULTS: In cell group, there was no new ventricular arrhythmia. NYHA improved from 2.6±0.5 to 1.7±0.9 at 352±160.4 days (P<0.001). LVEF increased from 27±5% to 35.1±9.6% at 273.6±172.8 days (P<0.001). There was no significant difference in changes of LVEF between combined OPCAB plus cell (+8.9±10.8 points percent) and cell alone (+7.8±5.6 points percent). Quality of life at 6 months has significantly improved for physical function, role emotional and mental health domains (all, P = 0.05). In control group, NYHA improved from 2.3±0.6 to 1.6±0.7 (P<0.001) however there was no significant improvement of LVEF (preop, 29.5±6% vs postop, 32.8±8%, P=0.08). Improvement of LVEF was significantly higher in cell group (P = 0.046).
CONCLUSIONS: Intramyocardial ACPs injection significantly improved NYHA class, LVEF and quality of life in ischemic cardiomyopathy. LVEF was significantly improved in cell group compared with control. Finally, randomized, double-blind, placebo-controlled trials are needed to more confirm the efficacy of this cell transplantation.
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