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J Am Coll Cardiol, 2003; 42:2063-2069, doi:10.1016/j.jacc.2003.06.017
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CELL TRANSPLANTATION

Catheter-Based intramyocardial injection of autologous skeletal myoblasts as a primary treatment of ischemic heart failure

Clinical experience with Six-Month Follow-Up

Pieter C. Smits, MD, PhD*,*, Robert-Jan M. van Geuns, MD, PhD{dagger}, Don Poldermans, MD, PhD*, Manolis Bountioukos, MD*, Emile E. M. Onderwater*, Chi Hang Lee, MD*, Alex P. W. M. Maat, MD* and Patrick W. Serruys, MD, PhD*

* Department of Cardiology, Thorax Center, Rotterdam, The Netherlands
{dagger} Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands

Manuscript received April 16, 2003; accepted June 4, 2003.

* Reprint requests and correspondence: Dr. Pieter C. Smits, Department of Cardiology, Thorax Center, Room Bd 412, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
p.c.smits{at}erasmusmc.nl

OBJECTIVES: We report on the procedural and six-month results of the first percutaneous and stand-alone study on myocardial repair with autologous skeletal myoblasts.

BACKGROUND: Preclinical studies have shown that skeletal myoblast transplantation to injured myocardium can partially restore left ventricular (LV) function.

METHODS: In a pilot safety and feasibility study of five patients with symptomatic heart failure (HF) after an anterior wall infarction, autologous skeletal myoblasts were obtained from the quadriceps muscle and cultured in vitro for cell expansion. After a culturing process, 296 ± 199 million cells were harvested (positive desmin staining 55 ± 30%). With a NOGA-guided catheter system (Biosense-Webster, Waterloo, Belgium), 196 ± 105 million cells were transendocardially injected into the infarcted area. Electrocardiographic and LV function assessment was done by Holter monitoring, LV angiography, nuclear radiography, dobutamine stress echocardiography, and magnetic resonance imaging (MRI).

RESULTS: All cell transplantation procedures were uneventful, and no serious adverse events occurred during follow-up. One patient received an implantable cardioverter-defibrillator after transplantation because of asymptomatic runs of nonsustained ventricular tachycardia. Compared with baseline, the LV ejection fraction increased from 36 ± 11% to 41 ± 9% (3 months, p = 0.009) and 45 ± 8% (6 months, p = 0.23). Regional wall analysis by MRI showed significantly increased wall thickening at the target areas and less wall thickening in remote areas (wall thickening at target areas vs. 3 months follow-up: 0.9 ± 2.3 mm vs. 1.8 ± 2.4 mm, p = 0.008).

CONCLUSIONS: This pilot study is the first to demonstrate the potential and feasibility of percutaneous skeletal myoblast delivery as a stand-alone procedure for myocardial repair in patients with post-infarction HF. More data are needed to confirm its safety.

Abbreviations and Acronyms
  DSE = dobutamine stress echocardiography
  ECG = electrocardiogram
  HF = heart failure
  ICD = implantable cardioverter-defibrillator
  LAO = left anterior oblique
  LV = left ventricle/ventricular
  LVEF = left ventricular ejection fraction
  MRI = magnetic resonance imaging
  NSVT = non-sustained ventricular tachycardia
  RAO = right anterior oblique
  TDI = tissue Doppler imaging




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