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

Miia Lehtinen; Tommi Pätilä; Esko Kankuri; Kirsi Lauerma; Juha Sinisalo; Mika Laine; Markku Kupari; Antti Vento; Ari Harjula; Helsinki BMMC Collaboration

doi:10.1016/j.healun.2015.01.989

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

J Heart Lung Transplant. 2015 Jul;34(7):899-905. doi: 10.1016/j.healun.2015.01.989. Epub 2015 Feb 7.

Authors

Miia Lehtinen¹, Tommi Pätilä², Esko Kankuri³, Kirsi Lauerma⁴, Juha Sinisalo⁵, Mika Laine⁵, Markku Kupari⁵, Antti Vento², Ari Harjula⁶; Helsinki BMMC Collaboration

Collaborators

Helsinki BMMC Collaboration:
Pekka Hämmäinen, Miia Holmström, Jukka Schildt, Aapo Ahonen, Päivi Nikkinen, Anne Nihtinen, Riitta Alitalo, Reino Pöyhiä

Affiliations

¹ Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital. Electronic address: miia.1.1ehtinen@helsinki.fi.
² Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital.
³ Institute of Biomedicine, Pharmacology, University of Helsinki.
⁴ Division of Roentgenology, HUS Medical Imaging Center.
⁵ Department of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
⁶ Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital; Institute of Biomedicine, Pharmacology, University of Helsinki.

PMID: 25797522
DOI: 10.1016/j.healun.2015.01.989

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.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Bone Marrow Transplantation / methods*
Female
Follow-Up Studies
Heart Failure / complications
Heart Failure / diagnosis
Heart Failure / therapy*
Humans
Leukocytes, Mononuclear / transplantation*
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardial Ischemia / complications
Myocardial Ischemia / diagnosis
Myocardial Ischemia / therapy*
Myocardium
Time Factors