Intracoronary Injection of Mononuclear Bone Marrow Cells in Acute Myocardial Infarction

Lunde, Ketil; Solheim, Svein; Aakhus, Svend; Arnesen, Harald; Abdelnoor, Michael; Egeland, Torstein; Endresen, Knut; Ilebekk, Arnfinn; Mangschau, Arild; Fjeld, Jan Gunnar; Smith, H.-J.; Taraldsrud, Eli; Grøgaard, Haakon K.; Bjørnerheim, Reidar; Brekke, Magne; Müller, Carl; Hopp, Einar; Ragnarsson, Àsgrìmur; Brinchmann, Jan E.; Forfang, Kolbjørn

doi:10.1056/nejmoa055706

Cited by 1,166 publications

(775 citation statements)

References 40 publications

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“…The average baseline ejection fraction was about 55% by contrast ventriculography, about 54% by echocardiography, and about 47% by MRI. In the trial conducted by Lunde et al, 6 there was no significant improvement in LVEF at 6 months in the mononuclear BMC group as compared to the control group. It may be worth mentioning that the number of stem cells administered to the patients was less than in the other studies and this may contribute to the lack of effectiveness in this study.…”

Section: Lvef Change Noted In Individual Studiesmentioning

confidence: 84%

“…In the study conducted by Wollert et al, 9 LV dysfunction was defined as hypokinesia or akinesia involving more than twothirds of the left ventricular anteroseptal, lateral, and/or inferior wall, as shown by angiography done immediately after PCI. In the trial by Lunde et al, 6 LV dysfunction was defined as 3 or more hypokinetic left ventricle segments observed on echocardiography. In the study by Schächinger et al, 5 LV dysfunction was defined as substantial residual left ventricular regional wall motion abnormality (as defined by an ejection fraction ≤45% according to a visual estimate).…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

“…The modalities used to evaluate change in global ejection fraction included magnetic resonance imaging (MRI), 6,8,9 LV angiography, 4,5 cardiac echocardiography, 6,7,10 and single photon emission computed tomography (SPECT). 6 We did not attempt to reclassify outcomes retrospectively, because such an attempt would not only be impractical, but would also create the potential for bias.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

“…Our search yielded 7 randomized controlled trials (Suárez de Lezo et al, 4 Schächinger et al, 5 Lunde et al, 6 Ge et al, 7 Janssens et al, 8 Wollert et al, 9 and Chen et al 10 ), evaluating changes in LVEF following intracoronary BMC therapy in relation to control groups. A meta-analysis of 516 patients (BMC group, 256; control group, 260) was performed (Table 1 and 2).…”

Section: Study Selectionmentioning

confidence: 99%

“…The variation in the LVEF could also be due to the fact that different modalities were used for the estimation of LVEF in the various trials included for meta-analysis: MRI, 6,8,9 LV angiography, 4,5 cardiac echocardiography, 6,7,10 and SPECT. 6 …”

Section: Limitationsmentioning

confidence: 99%

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Stem Cells Improve Left Ventricular Function in Acute Myocardial Infarction

Singh

Arora

Handa

et al. 2009

Clinical Cardiology

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BackgroundAnimal studies have suggested dramatic improvement in cardiac function after acute myocardial infarction (AMI) through regeneration of the myocardium or neovascularization by transfer of cells derived from bone marrow (BMC) generated clinical studies. Recently published small sized studies have yielded mixed results, leaving the question unanswered.HypothesisWe analyzed data from these studies in a meta‐analysis to investigate if intracoronary stem cell therapy was effective in improving cardiac function.MethodsA total of 7 randomized controlled trials meeting the inclusion criteria were identified by a systematic literature search. Primary endpoint was change in global left ventricular ejection fraction (LVEF) baseline to follow‐up (ranging between 3 to 6 months). The meta‐analysis consisted of 516 patients (BMC group, 256; control group, 260). A 2‐sided α error of less than .05 was considered to be statistically significant (P<.05).ResultsThere were no significant differences in patient characteristics between the BMC treatment and control groups at baseline. Compared to the control group, patients in the BMC treatment group had significantly greater increase in LVEF from baseline to follow‐up (mean difference: 6.108%; SE: 1.753%; 95% confidence interval [CI]: 2.672%− 9.543%; P<.001).ConclusionsThe present meta‐analysis suggests that intracoronary bone marrow stem cell infusion may be effective in improving left ventricular systolic function in patients after acute myocardial infarction. Copyright © 2009 Wiley Periodicals, Inc.

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Section: Lvef Change Noted In Individual Studiesmentioning

confidence: 84%

Section: Data Synthesis and Analysismentioning

confidence: 99%

Section: Data Synthesis and Analysismentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

See 3 more Smart Citations

Stem Cells Improve Left Ventricular Function in Acute Myocardial Infarction

Singh

Arora

Handa

et al. 2009

Clinical Cardiology

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Adult Bone Marrow–Derived Cells for Cardiac Repair

et al. 2007

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Background:The results from small clinical studies suggest that therapy with adult bone marrow (BM)derived cells (BMCs) reduces infarct size and improves left ventricular function and perfusion. However, the effects of BMC transplantation in patients with ischemic heart disease remains unclear.Methods: We searched MEDLINE, EMBASE, Science Citation Index, CINAHL (Cumulative Index to Nursing and Allied Health), and the Cochrane Central Register of Controlled Trials (CENTRAL) (through July 2006) for randomized controlled trials and cohort studies of BMC transplantation to treat ischemic heart disease. We conducted a random-effects meta-analysis across eligible studies measuring the same outcomes.Results: Eighteen studies (N = 999 patients) were eligible. The adult BMCs included BM mononuclear cells, BM mesenchymal stem cells, and BM-derived circulat-ing progenitor cells. Compared with controls, BMC transplantation improved left ventricular ejection fraction (pooled difference, 3.66%; 95% confidence interval [CI], 1.93% to 5.40%; PϽ.001); reduced infarct scar size (−5.49%; 95% CI, −9.10% to −1.88%; P=.003); and reduced left ventricular end-systolic volume (−4.80 mL; 95% CI, −8.20 to −1.41 mL; P=.006). Conclusions:The available evidence suggests that BMC transplantation is associated with modest improvements in physiologic and anatomic parameters in patients with both acute myocardial infarction and chronic ischemic heart disease, above and beyond conventional therapy. Therapy with BMCs seems safe. These results support conducting large randomized trials to evaluate the impact of BMC therapy vs the standard of care on patient-important outcomes.

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Intramyocardial Bone Marrow Cell Injection for Chronic Myocardial Ischemia

Ramshorst¹,

Bax²,

Beeres³

et al. 2009

JAMA

284

206

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ONE MARROW CELL THERAPY IS currently being investigated as a new therapeutic option for patients with ischemic heart disease. The goal of this treatment is to improve myocardial perfusion and contractile performance through administration of therapeutic cells into ischemically damaged myocardium. The majority of clinical studies conducted so far investigated whether intracoronary bone marrow cell infusion could enhance functional recovery after acute myocardial infarction. 1-3 Animal model studies, however, suggested that bone marrow cell therapy may also improve myocardial perfusion and increase left ventricular (LV) function in chronic ischemia. 4,5 A number of nonrandomized clinical studies indicated the safety and feasibility of intramyocardial bone marrow cell injection. 6-9 Moreover, a beneficial effect on myocardial perfusion and LV function was presumed. Until now, only 2 smallsized randomized controlled studies assessed the effect of bone marrow cell injection in patients with chronic myocardial ischemia. 10,11 Since the results of these 2 studies were discrepant, the beneficial effect of this treatment mo-Author Affiliations are listed at the end of this article.

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Intracoronary Injection of Mononuclear Bone Marrow Cells in Acute Myocardial Infarction

Abstract: With the methods used, we found no effects of intracoronary injection of autologous mononuclear BMC on global left ventricular function.

Cited by 1,166 publications

References 40 publications

Stem Cells Improve Left Ventricular Function in Acute Myocardial Infarction

Stem Cells Improve Left Ventricular Function in Acute Myocardial Infarction

Adult Bone Marrow–Derived Cells for Cardiac Repair

Intramyocardial Bone Marrow Cell Injection for Chronic Myocardial Ischemia

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