Influence of bone marrow stem cells on left ventricle perfusion and ejection fraction in patients with acute myocardial infarction of anterior wall: randomized clinical trial: Impact of bone marrow stem cell intracoronary infusion on improvement of microcirculation

Abstract

In our study, BMSC intracoronary transplantation in patients with anterior AMI did not result in increase in EF. Slight improvement of myocardial perfusion was noticed in the BMSC group. This finding may indicate better microcirculation enhanced by BMSCs, but small number of patients allow for hypothesis rather than final statement.

The effect of rigorous study design in the research of autologous bone marrow-derived mononuclear cell transfer in patients with acute myocardial infarction

“…Of these, 622 were nonrandomized studies, editorials, or reviews, and 83 of these were examined in more detail. Seventeen of the 83 references were eligible for inclusion [2][3][4][5][6][7][19][20][21][22][23][24][25][26][27][28][29] (Figure 1). …”

“…Nine of 17 trials implemented identical cardiac catheterization injection procedures after bone marrow aspiration in both the BMSC and control groups to maintain study blindness [2][3][4][5][6][7]19,21]. The surgeon was unaware whether cells or only saline was being injected.…”

The Role of PET with 13N-Ammonia and 18F-FDG in the Assessment of Myocardial Perfusion and Metabolism in Patients with Recent AMI and Intracoronary Stem Cell Injection

“…The last decade has seen the start of many clinical trials to assess the effect of intracoronary injection of stem cells on cardiac repair after AMI (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Nevertheless, the results obtained are still equivocal and suggest that differ- ences in the type and number of cells injected, administration mode, and follow-up time may hamper a proper assessment of the efficacy of this novel treatment (17,27,28).…”

“…Different imaging techniques have been used to assess the changes in cardiac function (3,4,(6)(7)(8)11,(13)(14)(15)17) and myocardial perfusion after stem cell transplantation (5,(8)(9)(10)(11). However, besides the evaluation of cardiac function obtained in all studies by means of LVEF estimation along with the measurement of other kinetic parameters, changes in myocardial flow have been assessed mostly with an automated quantification of infarct size calculated from MRI (7,8,14), perfusion scintigraphy (2,5,6,10,17), and 18 F-FDG PET images (29) or with a visual analysis of 99m Tc-sestamibi uptake in necrotic segments (16,30,31). The quantitative analysis of MBF already attempted with 11 C-acetate (8) but performed for the first time (to our knowledge) with ammonia in our study could provide a more accurate assessment of changes in cardiac perfusion in patients treated with bone marrow-or plasmaderived endothelial progenitors, as well as in patients who receive standard medical therapy for AMI.…”

“…The use of stem cells with angiogenic properties for therapy of myocardial infarction has been widely investigated, and several clinical studies have demonstrated the feasibility of intracoronary injection of various cell preparations derived from bone marrow and peripheral blood (2)(3)(4)(5)(6)(7)(8). Nevertheless, the efficacy of this novel treatment is still under investigation, it being unclear whether patients who have undergone stem cell therapy have a greater improvement in left ventricular function (LVEF) and a greater reduction of infarct size than do patients treated with standard therapy for AMI (3,4,(9)(10)(11)(12)(13)(14)(15)(16)(17). Besides the different imaging methods used for the estimation of LVEF and infarct size, a quantitative evaluation of myocardial blood flow (MBF) in scarred and non-infarct-related areas has been attempted only with 11 C-acetate PET (8).…”