Efficacy of Intramyocardial Injection of Angiogenic Cell Precursors for Dilated Cardiomyopathy: A Case Match Study
Kitipan V. Arom, Permyos Ruengsakulrach, Vibul Jotisakulratana; Cardiovascular Surgery, Bangkok Heart Hospital, Bangkok, Thailand
Comment on this Abstract
Objective: The objective is to determine efficacy of intramyocardial angiogenic cell precursors (ACPs) injection in dilated cardiomyopathy (DCM).
Methods: Thirty five DCM patients (cell group) underwent intramyocardial ACPs injection. Seventeen DCM patients (control group) from heart failure database treated by medical means were matched with the cell group. There was no statistically significant different between cell and control groups in relation to age, preoperative left ventricular ejection fraction (LVEF) and NYHA Class. In the cell group, mean age was 56.7 +/- 14.3 years. Mean LVEF was 23.9 +/- 6.5%. NYHA Class was 3.0 +/- 0.6. The ACPs were obtained from autologous blood and culture in vitro. ACPs express CD34, CD133, CD144, CD31Bright and secrete interleukin-8, vascular endothelial growth factor and angiogenin. The number of cells prior to injection was 20.7 +/- 17.9 million cells. The cells were injected into all areas of the left ventricle in the cell group.
Results: In the cell group: there was no new ventricular arrhythmia. NYHA class was improved by 1.1 +/- 0.7 (P < 0.001) at 284.7 +/- 136.2 days. Six-minute walk test improved (preop 369.5 +/- 122.4 vs postop 425 +/- 218.5 meters, P = 0.2) at 3 months follow up. The quality of life assessed by Short Form 36 demonstrated improving of physical function (P = 0.004), role-physical (P = 0.02), general health (P < 0.001) and vitality domains (P = 0.007) at 3 months follow up. The LVEF was improved in 71.4% of patients (25/35). The LVEF improved by 4.4 +/- 10.6 points % (P = 0.02) (from 23.9 +/- 6.5% to 28.3 +/- 10.7%) at 192.7 +/- 135.1 days. In the control group: there was no significant improvement of LVEF (preop LVEF 25.0 +/- 8.9 vs postop LVEF 27.6 +/- 7.6). The NYHA class was improved by 0.6 +/- 0.8 (from 2.45 +/- 0.9 to 1.9 +/- 0.5) (P = 0.052).
Conclusion: Intramyocardial ACPs injection is safe and effective in the DCM patients. The NYHA class, LVEF and quality of life were significantly improved in the cell group. Large randomized control trials are needed to confirm these results.
Back to 88th Annual Meeting
Back to Program Outline
