Intracoronary infusion of bone marrow‐derived mononuclear cells abrogates adverse left ventricular remodelling post‐acute myocardial infarction: insights from the reinfusion of enriched progenitor cells and infarct remodelling in acute myocardial infarction (REPAIR‐AMI) trial

Abstract

AimsDepressed left ventricular ejection fraction (LVEF) despite successful reperfusion therapy is the single most powerful predictor of progressive LV enlargement after acute myocardial infarction (AMI) and independently determines adverse outcome in these patients. Methods and resultsWe investigated the effect of intracoronary administration of bone marrow-derived mononuclear cells (BMC) within 7 days after successful reperfusion therapy for AMI, on early (within 4 months) LV remodelling processes assessed by quantitative LV angiography. Overall, 95 patients received BMC and 92 patients received placebo. Remodelling was assessed as the changes in either LVEF and end-systolic volume (ESV) or stroke volume and end-diastolic volume (EDV) at 4 months, respectively. Baseline LVEF was inversely correlated with ESV expansion at 4 months in the placebo group, but not in the BMC group. Likewise, EDV expansion was significantly correlated with baseline LVEF in the placebo (r ¼ 20.36, P , 0.001), but not in the BMC group (r ¼ 20.17, P ¼ 1.0). Analysing the interaction between convalescent LV contractile function and LV volumes revealed that the increase in LVEF or stroke volume did not occur at the expense of increases in ESV or EDV, respectively, in the BMC group. ConclusionIntracoronary administration of BMC eliminates the correlation between depressed LVEF after reperfusion therapy and LV expansion during follow-up and, thereby, abrogates early LV remodelling after AMI.--

Effects of Stem Cell Therapy on Left Ventricular Remodeling After Acute Myocardial Infarction: A Meta‐Analysis

“…Four of these studies 21,23,28,31 reported a statistically significant reduction in LVESV after cell therapy, while changes in the other 7 comparisons did not reach statistical significance. The characteristics of subjects (age, gender, hypertension, hyperlipidemia,diabetes mellitus [DM], anterior AMI proportion, smoking, baseline characteristics), study design and/or treatment regimen (average number of injected cells, CD34…”

“…Myocardial infarction leads to the loss of cardiomyocytes, followed by pathological LV remodeling and progression Jin-Ho Choi [30] Huikuri HV [29] Meluzin J(Low) [28] Meluzin J(Hi) [28] MAGIC Cell-3-DES [27] Janssens S [25] BOOST (18) [24] BOOST(6) [24] Li Zhan-quan [23] REPAIR-AMI [21] Study ID Figure 3. Effects of stem cell therapy compared with standard treatment on changes in LVESV in post-AMI patients.…”

“…21 -25,27 -29 Sham infusion was used in 3 trials. 21,25,29 A total of 7 studies 21,24,25,27 -30 reported adequate details of withdraws, whereas the others did not address this issue.…”

Bone Marrow Derived Pluripotent Stem Cells in Ischemic Heart Disease: Bridging the Gap Between Basic Research and Clinical Applications

“…The results from these studies varied widely probably secondary to the heterogeneous methodologies used with an overall marginal benefit with www.intechopen.com BM-derived cell transplantation compared to placebo. The majority of studies, however, utilized unselected populations of BMCs and these studies provide the longest follow-up of up to 5 years (Assmus et al, 2010;Schachinger et al, 2009). The underling mechanisms leading to the beneficial effect of transplanted BMCs are unclear.…”

Heart to Heart

“…[7][8][9] Although the overall efficacy is modest, certain subgroups (particularly those with large functional deficits at baseline) do experience clinically meaningful increments in ejection fraction. 10,11 A related consideration arises in the choice of cell type to transplant. BMCs, although easy to harvest, are almost certainly not the best candidate cells for cardiomyoplasty, because they are not specialized to regrow normal healthy heart muscle.…”