Usefulness of Intramyocardial Injection of Autologous Bone Marrow–Derived Mononuclear Cells in Patients With Severe Angina Pectoris and Stress-Induced Myocardial Ischemia

• Published in: The American journal of cardiology Vol. 97; no. 9; pp. 1326 - 1331
• Main Authors: Beeres, Saskia L.M.A., Bax, Jeroen J., Kaandorp, Theodorus A.M., Zeppenfeld, Katja, Lamb, Hildo J., Dibbets-Schneider, Petra, Stokkel, Marcel P.M., Fibbe, Willem E., de Roos, Albert, van der Wall, Ernst E., Schalij, Martin J., Atsma, Douwe E.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2006; Elsevier; Elsevier Limited
• Subjects: Angina pectoris; Angina Pectoris - therapy; Biological and medical sciences; Bone marrow; Bone Marrow Transplantation; Cardiology. Vascular system; Cells; Coronary Circulation - physiology; Coronary heart disease; Exercise Test; Exercise Tolerance - physiology; Female; Follow-Up Studies; Heart; Heart - diagnostic imaging; Heart Ventricles - pathology; Humans; Injections; Injections, Intramuscular; Leukocytes, Mononuclear - transplantation; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Myocardial Ischemia - therapy; Myocarditis. Cardiomyopathies; Quality of Life; Stress; Stroke Volume - physiology; Systole - physiology; Tomography, Emission-Computed, Single-Photon; Transplantation, Autologous; Transplants & implants; Treatment Outcome; Ventricular Function, Left - physiology; Human; Cardiovascular disease; Myocardial ischemia; Autologous system; Injection; Angina pectoris; Coronary heart disease; Myocardial disease; Phlebology; Stress; Vascular disease; Mononuclear cell; Bone marrow; Circulatory system; Intramyocardial; Cardiology; Severe
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2005.11.068

Bone marrow cell transplantation has been proposed as a novel therapeutic option for patients with coronary artery disease. This study investigated whether autologous bone marrow–derived mononuclear cell injection into the ischemic myocardium of patients with severe angina pectoris could safely reduce anginal symptoms, improve myocardial perfusion, and increase left ventricular (LV) function. In a total of 20 patients (63 ± 10 years old; 16 men) with angina pectoris, myocardial segments with stress-induced ischemia as assessed by gated single-photon emission computed tomography were injected with 30 to 100 million mononuclear cells. Anginal symptoms, Canadian Cardiovascular Society class, and quality of life were assessed at 3 and 6 months of follow-up. At baseline and 3 months of follow-up, an exercise test, gated single-photon emission computed tomography, and magnetic resonance imaging were performed to assess exercise capacity, myocardial perfusion, and LV function. Intramyocardial injection of autologous bone marrow–derived mononuclear cells was safe. The Canadian Cardiovascular Society class improved from 3.5 ± 0.5 at baseline to 2.4 ± 0.6 after 3 months (p <0.01) and 2.4 ± 0.6 after 6 months (p <0.01). The quality-of-life score improved from 52 ± 10% to 71 ± 10% at 3 months (p <0.01) to 73 ± 15% at 6 months (p <0.01). The exercise capacity increased from 79 ± 31% to 84 ± 29% (p <0.05). Magnetic resonance imaging revealed an increased LV ejection fraction from 51 ± 11% to 54 ± 10% (p <0.01) and a reduced LV end-systolic volume from 97 ± 50 to 88 ± 42 ml (p <0.01). The wall motion score index improved from 0.36 ± 0.32 to 0.24 ± 0.28 (p <0.01). The number of segments with stress-induced ischemia decreased from 5.1 ± 3.2 to 2.3 ± 2.6 (p
<0.01). In conclusion, autologous bone marrow–derived mononuclear cell injection in patients with ischemia is safe, reduces anginal symptoms, improves myocardial perfusion, and increases LV function.