| Clinical Study on Intracoronary Autologous Bone MarrowMononuclear Cells Transplantation on the Cardiac Function inPatients with Anterior-wall Myocardial InfarctionPost-infarction heart failure remains a major cause of morbidity and mortality. Although medical therapy and prompt reperfusion of the occluded artery have significantly reduced early mortality rates, however, unfortunately, myocardial necrosis starts rapidly after coronary occlusion, usually before reperfusion can be achieved. The loss of viable myocardium initiates a process of adverse left-ventricular remodeling, leading to chamber dilatation and contractile dysfunction in many patients. The major goal to improve post-infarction prognosis would be the stimulation of neovascularization and the enhancement of regeneration of cardiac myocyte within the infarct area.Recent experimental studies suggested the bone marrow mononuclear cells (BMMCs), peripheral hemopoietic stem cell or circulating progenitor cells might contribute to the regeneration of infarction myocardium and enhance neovascularization of ischemic myocardium. A few previous clinical trials all transplanted in one week after acute myocardial infarction, and the results showed that cell transplantation could improve global left-ventricular ejection fraction. However, it is not identify if emergent intracoronary infusion of BM-MNCs and transplantation in convalescent period or advanced stage are applicable and effective on improving the left ventricular function.Clinical Trail on Emergent Intracoronary Autologous Bone MarrowMononuclear Cells Transplantation on the Cardiac Function inPatients with Acute Anterior-wall Myocardial InfarctionObjective: To evaluate the effects of emergent intracoronary transfer of bone marrow mononuclear cells (BMMCs) on left ventricular function and myocardial perfusion in patients with first acute anterior myocardial infarction.Method: After successful emergent percutaneous coronary intervention (PCI) for acute ST-segment elevation anterior wall myocardial infarction, Twenty-nigh patients were randomly assigned to either a control group (n=15) that received optimum postinfarction medical treatment, or a BMMC transplantation (BMT) group (n=14). In BMT group, bone marrow was instantly aspirated from ilium and the autologous BMMCs were injected to the anterior descending branch through an infusion catheter within 3 hours after stenting, and patients then received optimum postinfarction medical treatment. Endpoint was the change in global and regional left ventricular function, and the amelioration of myocardial perfusion through 201-thallium scintigraphy in 6 months follow-up.Results: left ventricular ejection function (LVEF) at baseline (determined 1 week after PCI by echocardiography) was 55.0±6.7% in control group and 55.3 + 8.3% in the BMC group, which are similar between the two groups. After 6 months, mean LVEF had decreased by 0.1% in the control group but increased by 5.0% in the BMC group (P=0.015). By quantitative LV angiography at 6 months, global LVEF significantly increased in BMT group (51.4 ± 11.1 % before transfer vs 58.7% ± 11.6%, P=0.046, n=10), but decreased in the control group (52.5 + 10.4% vs 51.6% ± 14.0% , P=0.61, n=10). In addition, there was a significant improvement of left ventricular myocardial perfusion at 6 months in BMT group valuated by the semiquantitative score of myocardial perfusion defects, which were decreased from 22.6 ±9.2 at one week after PCI to 13.3 ± 11.2 (P=0.002). No severe ventricular arrhythmia exists in both groups. Conclusions: In patients with acute anterior myocardial infarction, emergency intracoronary transfer of autologous BMMCs... |
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