BENEFICIAL EFFECT OF COMBINED (INTRAMYOCARDIAL AND INTRACORONARY) BONE MARROW-DERIVED STEM CELLS THERAPY IN PATIENTS WITH ISCHAEMIC HEART DISEASE AND SEVERLY DEPRESSED LEFT VENTRICULAR FUNCTION

Background: Implantation of bone marrow-derived stem cells (BM-SCs) into the failing heart may be a promising approach for cardiac regeneration in heart failure secondary to severe coronary artery disease.

Aim: The aim of the present study was to determine the effects of the combined (intramyocardial and intracoronary) percutaneous administration of non-selected BM-SCs therapy on the size of ischaemia, the clinical status and left ventricular function in no option patients with chronic myocardial ischaemia and severely depressed left ventricular function.
 Methods: Eighteen patients (94% men, mean age: 55.410.5 years) with previous myocardial infarction and left ventricular ejection fraction less than 35% under optimal medical treatment received combined NOGA-guided intramyocardial (4.00.6 ml) plus intracoronary (30.213.8 ml) autologous BM-SCs therapy (total cell number: 2.82x1093.39 x109; CD34+ cell number: 4.60x1074.41x107). Baseline and 6-month follow up 99m-Tc-MIBI-adenosin-perfusion scintigraphy for determination of size of resting and stress-induced perfusion defects, NOGA endocardial mapping for assessment of myocardial viability, contrast ventriculography for calculating of global left ventricular ejection fraction (EF), left ventricular end-systolic (ESV) and end-diastolic volume (EDV) were performed in all patients.
Results: A positive trend to smaller stress-induced perfusion defects (from 37.312.0% to 32.911.6%; p=0.07) and significant increase in mean unipolar voltage value of injected area measured by NOGA endocardial mapping (from 7.242.33 mV to 8.432.70 mV; p=0.007) (normal value > 14 mV) was observed after 6-month combined application form of BM-SCs therapy. Accordingly, the clinical status of patients improved (NYHA functional class from 2.690.96 to 1.740.95; p=0.001,