Clinical improvement after autologous bone marrow mononuclear cell transplantation

Background

Our group and others have reported symptoms, myocardial perfusion and mechanical improvements with bone marrow mononuclear cell (BM-MNC) transplantation into areas of hibernating myocardial in end stage ischemic heart disease (ESIHD) patients. However, there is no information about the course of these improvements during time. We evaluated, week by week, the improvements in New York Heart Association (NYHA) functional class, CCS angina class and ejection fraction (EF) by echocardiography in ESIHD patients to BM-MNC transendocardial delivery.

Methods

In 14 patients, bone marrow was harvested from iliac crest and BM-MNCs were selected by Ficoll gradient. Endocardial injections targeting hibernated myocardial areas were performed utilizing electromechanical mapping (MyoStar, Cordis, Miami Lakes, FL, USA). At baseline and during a follow-up of 10 weeks the patients were evaluated about their NYHA functional class, CCS angina class, and EF by echo (Simpson). Ischemic area was evaluated by SPECT-MIBI (Siemens ICON workstation) before and 8 weeks after BM-MNC transplantation. The statistical analysis used for comparisons between baseline and 8 weeks was analysis of variance, and that for evaluation of peak of improvements during time was a generalized linear model with time strata.

Results

All 14 patients (two females, 57 ± 10 years old) had multi-vessel disease and previous myocardial infarction. The patients presented a significant 73% reduction in total reversibility defect (P = 0.022, from 15.15 ± 14.99% to 4.53 ± 10.61%) in an 8 week follow-up. The NYHA class were 2.21 ± 0.89 at baseline and improved to 1.14 ± 0.36 at 8 weeks (P = 0.0003). The CCS angina class were 2.64 ± 0.84 at baseline and improved to 1.28 ± 0.61 (P = 0.0001). The EF moved from 30 ± 5% at the baseline to 35 ± 7% at 8 weeks (P = 0.02). We obtained a significant improvement of NYHA at the fourth week (P = 0.0002) and for CCS at the seventh week (P = 0.000006). Concomitantly we observed a significant improvement in EF by echo between the sixth and eighth weeks (P = 0.04).

Conclusion

These preliminary data suggest a time window for clinical, functional and myocardial perfusion improvements with BM-MNC transplantation during the second month of follow-up. This data, if confirmed in more powerful studies, may be useful for informing patients submitted to BM-MNC transplantation to hibernating myocardial areas, as well as to identify the major mechanism involved in this approach.