Background-This study evaluated the hypothesis that transendocardial injections of autologous mononuclear bone marrow cells in patients with end-stage ischemic heart disease could safely promote neovascularization and improve perfusion and myocardial contractility. Methods and Results-Twenty-one patients were enrolled in this prospective, nonrandomized, open-label study (first 14 patients, treatment; last 7 patients, control). Baseline evaluations included complete clinical and laboratory evaluations, exercise stress (ramp treadmill), 2D Doppler echocardiogram, single-photon emission computed tomography perfusion scan, and 24-hour Holter monitoring. Bone marrow mononuclear cells were harvested, isolated, washed, and resuspended in saline for injection by NOGA catheter (15 injections of 0.2 cc). Electromechanical mapping was used to identify viable myocardium (unipolar voltage Ն6.9 mV) for treatment. Treated and control patients underwent 2-month noninvasive follow-up, and treated patients alone underwent a 4-month invasive follow-up according to standard protocols and with the same procedures used as at baseline. Patient population demographics and exercise test variables did not differ significantly between the treatment and control groups; only serum creatinine and brain natriuretic peptide levels varied in laboratory evaluations at follow-up, being relatively higher in control patients. At 2 months, there was a significant reduction in total reversible defect and improvement in global left ventricular function within the treatment group and between the treatment and control groups (Pϭ0.02) on quantitative single-photon emission computed tomography analysis. At 4 months, there was improvement in ejection fraction from a baseline of 20% to 29% (Pϭ0.003) and a reduction in end-systolic volume (Pϭ0.03) in the treated patients. Electromechanical mapping revealed significant mechanical improvement of the injected segments (PϽ0.0005) at 4 months after treatment. Conclusions-Thus, the present study demonstrates the relative safety of intramyocardial injections of bone marrowderived stem cells in humans with severe heart failure and the potential for improving myocardial blood flow with associated enhancement of regional and global left ventricular function. (Circulation. 2003;107:2294-2302.)

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Introduction Cardiopulmonary exercise testing (CPET) has become an important clinical tool to predict outcome in patients with chronic heart failure (CHF) and help to select candidates for heart transplantation (HTx) or left ventricular assist devices (LVAD). Purpose To evaluate CPET measurements in advanced CHF patients that are being considered for HTx or LVAD and its association to early mortality regardless of the performed procedure. Methods Maximum intensity CPET was performed on a treadmil and ramp protocol in 65 patients with patients with CHF and reduced ejection fraction, NYHA functional classes III and IV between 2012 and 2018. Measurements derived from CPET were the following: peak V'O2, VO2 at the anaerobic threshold (AT), percentage of the VO2 of the anaerobic threshold in relation to the peak, the VE/VCO2 slope, maximum heart rate (HR), respiratory quotient (R), oxygen kinetics, circulatory power (CP), the recovery HR in the first minute and the oxygen uptake efficiency slope (OUES) and the relation (VE/VCO2 slope)/VO2 peak. Results Seventy-four percent were male. Mean age of 67±12 years. Amost half (47%) had ischemic etiology. There were no complications related to CPET. Ten patients were transplanted, six had an intracorporeal LVAD implanted and the reminder (49 patients) were kept in supervised physical rehabilitation program. There were 11 deaths, 2 in HTx, 2 in LVAD, 7 in the rehabilitation group. Mean follow-up among the survivors was 43 months ± 40.6 and it was 12.1±10.3 months in those who died. CPET derived measurements between survivors and non-survivors were as follows: V'O2 peak (mL kg–1 min–1): 12.6±4.6 and 8.6±2.7 (p=0.002); the VO2 AT (mL kg–1 min–1): 9.9±3.3 and 6.1±3.0 (p=0.002); VE/VCO2 slope: 34.2±12.1 and 68.1±68.7 (p=0.0003); R peak: 1.1±0.2 and 1.0±0.1 (p=0.009); t1/2, in seconds: 135.8±47.9 and 170.1±82.0 (p=0.03); HR at the first minute 16.6±13 and 7±5 (p=0.009); OUES (L min–1): 1.1±0.4 and 0.9±0.3 (p=0.04) and CP [(ml O2 kg–1 min–1) mmHg] 1.516.2±689. 3 and 960.6±363.6 (p=0.005). and the relation (VE/VCO2 slope)/V'O2 peak were 3.2±2.0 and 11.4±19.5 (p=0.001), respectively. Conclusion The predisposition to early death could be stratified by V'O2 peak, VO2 of the ventilatory threshold, VE/VCO2 slope, t1/2, recovery HR, OUES, CP, and by the relation (VE/VCO2 slope)/V'O2 peak. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): own financing

Objectives: In the treatment of acute myocardial infarction (MI), the time delay to achieve reperfusion of the infarction-related artery has been linked to survival rates. Primary or direct angioplasty has been found to be an excellent means of achieving reperfusion in acute ST-elevation MI compared to thrombolytic therapy in randomized trials. However, no mortality benefit of primary angioplasty over thrombolysis was observed in several registries, in which delays in performing primary angioplasty were longer. Our objectives were to evaluate the door-to-balloon time (DBT) in our institution and investigate its relationship with clinical and prognostic variables. Methods:We studied, retrospectively, 67 patients submitted to primary angioplasty, from January 1999 to November 2000. We divided our patient population into two groups. Group A (GA) included patients with DBT less than 120 min and group B (GB) patients with DBT greater or equal to 120 min. We evaluated several clinical variables, such as left ventricular ejection fraction (LVEF) on their first echocardiogram during hospitalization, admission Killip classification, in-hospital length of stay (LOS) and major cardiovascular events (MACE) during hospitalization and up to 6-month follow-up (in 23 patients). Results:The median DBT was 132 min and the mean was 165 min, with a standard deviation of 137 min for all the cases. We had 32 patients in the GA and 35 patients (52%) in the GB. We observed four in-hospital deaths, all in GB. The mean LVEF was 53.1 ± 9% in GA and 46.1 ± 13% in GB (P = 0.059). Admission Killip class greater than 1 was noted in three patients of each group. The in-hospital LOS was similar for both groups (GA = 8.35 ± 4 and GB = 8.33 ± 4 days; NS). In-hospital events occurred in eight patients of GA (25%) and seven patients of GB (20%; NS). Only five follow-up events occurred during the first 6 months, three events in GA patients and two in GB patients (NS). Conclusion:DBT greater than or equal to 2 h are common and in our population it occurred in more than half of the primary angioplasties. Greater than 2 h DBTs were associated with a trend to larger left ventricular dysfunction early after MI. Monitoring and measures to reduce DBT are crucial for the potential prognosis improvement offered by primary angioplasty and for the broadening of its use in the management of acute MI. P2Primary angioplasty versus streptokinase in elderly patients with acute myocardial infarction PF Leite, M Park, VS Kawabata, MS Barduco, S Timerman, LF Cardoso, JAF Ramires Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil Because only a few studies about acute myocardial infarction (AMI) include elderly patients, we compared outcomes of patients aged 70 years or older with AMI who underwent thrombolysis or primary angioplasty treatment. Methods:From April 1995 to June 1999, 64 patients within 12 h of symptom onset and no contraindications for thrombolytic therapy were randomized in two groups. Group I (32 patients, 20 men) sub...