Exercise capacity, arrhythmic risk profile, and pulmonary function is not influenced by intracoronary injection of Bone Marrow Stem Cells in patients with acute myocardial infarction
ABSTRACT To evaluate influence of Bone Marrow Stem Cells (BMSC) intracoronary infusion on exercise capacity, pulmonary function, heart rate recovery and SAECG in patients with AMI of anterior wall, compared to control group--from baseline in the acute phase during 12 months follow up.
Forty five patients were randomized 2:1 to BMSC group (n = 31 pts) or to control group (n = 14 pts). BMSC were administered into infarct related artery (IRA) at 4-6 day after primary PCI. Patients were followed up with cardiopulmonary exercise testing. The QRS duration, QT and QTc interval were measured and signal averaged ECGs (SAECG) were performed to evaluate late potentials.
There were no significant differences between both groups neither at peak VO(2) (190.7 ± 7.4 at baseline; 24.2 ± 5.2 at 6 months; 22.2 ± 7.4 ml/kg/min at 12 months vs 18.4 ± 8.2 at baseline; 22.0 ± 7.2 at 6 months; 21.8 ± 6.2 ml/kg/min at 12 months; BMSC vs control group respectively; p = ns), nor VO(2) at anaerobic threshold, nor in VE/VCO(2) slope, RER, and systolic blood pressure at peak exercise at baseline and any time point of follow-up. There were no significant differences between groups concerning HR peak, HRR1 and HRR2 at any time point and also QRS, QT parameters, and SAEKG. There were no significant differences between both groups at any time point (baseline, 6 and 12 months) concerning FVC, FEV(1) and FVC/FEV(1) and % of their normal values.
We did not find that BMSC therapy in patients with anterior wall myocardial infarction influences exercise capacity. We did not confirm it's potential proarrhythmogenic influence as assessed with SAECG and standard ECG analysis.
[Show abstract] [Hide abstract]
ABSTRACT: Despite optimal medical therapy, cardiovascular disease remains a leading cause of morbidity and mortality worldwide. One emerging therapeutic approach for treatment of cardiomyopathies is stem cell therapy. Use of stem cells for regenerative medicine has quickly evolved over the last decade. On the basis of encouraging pre-clinical results, stem cell therapy has developed rapidly into a potentially promising treatment for ischemic heart disease, myocardial infarction and congestive heart failure. In this review, we summarize the current state-of-the-art of stem cell therapy and compare collective experiences gleaned from trials using intravenous, intra-coronary and intra-myocardial delivery in exacting credible benefits. We discuss implications of clinical outcomes reported in relation to the delivered stem cells as probable destiny therapy for cardiovascular repair.Cytotherapy 01/2013; 15(4). DOI:10.1016/j.jcyt.2012.11.003 · 3.06 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: After the onset of ischemia, cardiac or skeletal muscle undergoes a continuum of molecular, cellular, and extracellular responses that determine the function and the remodeling of the ischemic tissue. Hypoxia-related pathways, immunoinflammatory balance, circulating or local vascular progenitor cells, as well as changes in hemodynamical forces within vascular wall trigger all the processes regulating vascular homeostasis, including vasculogenesis, angiogenesis, arteriogenesis, and collateral growth, which act in concert to establish a functional vascular network in ischemic zones. In patients with ischemic diseases, most of the cellular (mainly those involving bone marrow-derived cells and local stem/progenitor cells) and molecular mechanisms involved in the activation of vessel growth and vascular remodeling are markedly impaired by the deleterious microenvironment characterized by fibrosis, inflammation, hypoperfusion, and inhibition of endogenous angiogenic and regenerative programs. Furthermore, cardiovascular risk factors, including diabetes, hypercholesterolemia, hypertension, diabetes, and aging, constitute a deleterious macroenvironment that participates to the abrogation of postischemic revascularization and tissue regeneration observed in these patient populations. Thus stimulation of vessel growth and/or remodeling has emerged as a new therapeutic option in patients with ischemic diseases. Many strategies of therapeutic revascularization, based on the administration of growth factors or stem/progenitor cells from diverse sources, have been proposed and are currently tested in patients with peripheral arterial disease or cardiac diseases. This review provides an overview from our current knowledge regarding molecular and cellular mechanisms involved in postischemic revascularization, as well as advances in the clinical application of such strategies of therapeutic revascularization.Physiological Reviews 10/2013; 93(4):1743-802. DOI:10.1152/physrev.00006.2013 · 29.04 Impact Factor