CLINICAL RESEARCH
Catheter-based autologous bone marrow myocardial injection in no-option patients with advanced coronary artery disease
A feasibility study
Shmuel Fuchs, MD*,*,
Lowell F. Satler, MD*,
Ran Kornowski, MD ,
Petros Okubagzi, MD*,
Giora Weisz, MD ,
Richard Baffour, MD*,
Ron Waksman, MD*,
Neil J. Weissman, MD*,
Manuel Cerqueira, MD*,
Martin B. Leon, MD and
Stephen E. Epstein, MD*
* Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC, USA
Rabin Medical Center, Petach-Tikva, Israel
Cardiovascular Research Foundation, Lenox Hill Hospital, New York, New York, USA
Manuscript received October 21, 2002;
revised manuscript received February 5, 2003,
accepted February 13, 2003.
* Reprint requests and correspondence: Dr. Shmuel Fuchs, Cardiovascular Research Institute, Washington Hospital Center, 110 Irving Street NW, 4B-1, Washington, DC 20010, USA.
sfuchsel2002{at}yahoo.com
OBJECTIVES: We conducted a pilot study to evaluate the feasibility of transendocardial delivery of autologous bone marrow (ABM) strategy in patients with severe symptomatic chronic myocardial ischemia not amenable to conventional revascularization.
BACKGROUND: Transendocardial injection of ABM cells appears to enhance perfusion of ischemic porcine myocardium.
METHODS: Ten patients underwent transendocardial injection of freshly aspirated and filtered unfractionated ABM using left ventricular electromechanical guidance. Twelve injections of 0.2 ml each were successfully delivered into ischemic noninfarcted myocardium pre-identified by single-photon emission computed tomography perfusion imaging.
RESULTS: Autologous bone marrow injection was successful in all patients and was associated with no serious adverse effects; in particular, there was no arrhythmia, evidence of infection, myocardial inflammation, or increased scar formation. Two patients were readmitted for recurrent chest pain. At three months, Canadian Cardiovascular Society angina score significantly improved (3.1 ± 0.3 vs. 2.0 ± 0.94, p = 0.001), as well as stress-induced ischemia occurring within the injected territories (2.1 ± 0.8 vs. 1.6 ± 0.8, p < 0.001). Treadmill exercise duration, available in nine patients, increased, but the change was not significant (391 ± 155 vs. 485 ± 198, p = 0.11).
CONCLUSIONS: This study provides preliminary clinical data indicating feasibility of catheter-based transendocardial delivery of ABM to ischemic myocardium.
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Abbreviations and Acronyms
| | ABM | | autologous bone marrow | | BM | | bone marrow | | CCS | | Canadian Cardiovascular Society | | CK | | creatine kinase | | EF | | ejection fraction | | HUVECs | | human umbilical endothelial cells | | LV | | left ventricle/ventricular | | MCP-1 | | macrophage chemoattractant protein-1 | | SPECT | | single-photon emission computed tomography | | VEGF | | vascular endothelial growth factor |
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