Recent studies suggest that myocardial administration of stem cells improves perfusion and function of ischemic myocardium. The present study evaluated the safety and efficacy of simple intracoronary administration of mononuclear autologous bone marrow (BM) cells in patients with ischemic
cardiomyopathy without revascularization option.
METHODS AND RESULTS: We enrolled 6 consecutive patients with ischemic
cardiomyopathy, who were in New York Heart Association classes III to IV despite optimal medical treatment without revascularization options and who, on
dobutamine stress echocardiograph (DSE), were found to have left ventricular ejection fraction < 35% with significant hibernation and
ischemia in at least 2 myocardial segments. BM cell
suspension was collected, and on the next day, during coronary angiography, mild
ischemia was induced by a short balloon inflation in each coronary conduit with a TIMI flow of > or = 2 followed by slow infusion of up to 50 mL of BM cells
suspension to each conduit. At baseline and 4 months' follow-up, patients underwent clinical evaluation, Holter monitoring, and DSE. BM infusion was successful in all patients. One patient developed postprocedure
hypotension and
troponin increase. At 4 months' follow-up New York Heart Association class improved from 3.5 +/- 0.5 to 2.3 +/- 1.0, P = .04, and resting ejection fraction improved from 25% +/- 7% to 28% +/- 8%, P = .055. We observed improvement in resting wall motion score only in the segments with hibernation in baseline DSE (2.3 +/- 0.5 to 2.0 +/- 0.6, P = .03) and improvement in high-dose
dobutamine wall motion score, only in segments showing significant
ischemia at baseline DSE (2.5 +/- 0.5 to 2.0 +/- 0.6, P = .001). There were no clinical arrhythmias or increased
arrhythmia burden by Holter monitoring.
CONCLUSIONS: