Improved Regional Function After Autologous Bone Marrow-Derived Stem Cell Transfer in Patients With Acute Myocardial Infarction - Improved Regional Function After Autologous Bone Marrow-Derived Stem Cell Transfer in Patients With Acute Myocardial Infarction

Description:

The goal of the trial was to evaluate treatment with bone marrow-derived progenitor cells (BMPCs) early after reperfusion for acute myocardial infarction (MI).

Hypothesis:

Intracoronary infusion of BMPCs would be more effective in improving regional myocardial function (or deformation).

Study Design

  • Placebo Controlled
  • Randomized
  • Blinded
  • Parallel

Patients Enrolled: 67
Mean Follow Up: 4 months
Mean Patient Age: 55 years
Female: 18%
Mean Ejection Fraction: 56%

Patient Populations:

  • Patients with acute MI more than 2 hours from symptom onset with at least 6 mm of cumulative ST-segment elevation who underwent reperfusion therapy with stent implantation
  • Left ventricular systolic dysfunction

Exclusions:

  • Prior MI

Primary Endpoints:

  • Regional myocardial function defined by velocity-derived strain rate imaging

Secondary Endpoints:

  • Change in left ventricular ejection fraction

Drug/Procedures Used:

Patients with acute MI were randomized to intracoronary infusion of bone marrow progenitor cells harvested from the iliac crest (n = 33) or placebo (n = 34).

Principal Findings:

Overall, 67 patients were randomized. There was no difference in baseline characteristics between the groups. Mean age was 55 years, 18% of patients were women, body mass index was 26 kg/m2, left anterior descending was the infarct-related artery in 64% of patients, systolic blood pressure was 134 mm Hg, and median time to intervention was 3.7 hours.

At 4 months of follow-up, improvement in end-systolic strain was -8.2% ± 7.2% in the BMPC group versus -4.7% ± 8.3% with placebo (treatment effect -3.7% ± 1.0%, p = 0.0003). Peak-systolic strain rate was improved with BMPC (treatment effect -0.20 sec-1 ± 0.07 sec-1, p = 0.0035), as was recuperation of the mitral valve ring displacement (treatment effect 0.93 mm ± 0.43 mm, p = 0.034).

The mean baseline ejection fraction was 56% in the BMPC group versus 53% with placebo. At 4-month follow-up, the mean ejection fraction had increased an absolute 3.5% in the BMPC group versus 5.0% with placebo (p = 0.84).

At 4 months, systolic blood pressure was 119 mm Hg in the BMPC group versus 131 mm Hg with placebo (p = 0.0062). One patient died in the BMPC group due to intra-abdominal hemorrhage from excessive anticoagulation.

Interpretation:

Early infusion of BMPC after an acute MI improves regional myocardial function. This was shown by an improvement in end-systolic strain, peak-systolic strain, and mitral valve displacement within the infarcted segments. There was no improvement in left ventricular ejection fraction at follow-up.

This study showed that infusion of BMPC after an acute MI is feasible and improves certain indices of myocardial function. It is unknown if patients with worse left ventricular systolic function at baseline would have benefited more from this therapy. While the difference in follow-up blood pressure may have been due to chance, it is possible that this effect could have accounted for some of the improvement in regional myocardial function. Future studies are needed to determine if BMPC can safely improve clinical outcomes.

References:

Herbots L, D’hooge J, Eroglu E, et al. Improved regional function after autologous bone marrow-derived stem cell transfer in patients with acute myocardial infarction: a randomized, double-blind strain rate imaging study. Eur Heart J 2008;Dec 23:[Epub ahead of print].

Clinical Topics: Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention

Keywords: Myocardial Infarction, Follow-Up Studies, Bone Marrow, Body Mass Index, Stem Cells, Ventricular Remodeling, Coronary Disease, Stroke Volume, Blood Pressure, Mitral Valve, Stents


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