Randomized, controlled trial of intramuscular or intracoronary injection of autologous bone marrow cells into scarred myocardium during CABG versus CABG alone

Keng Leong Ang, Derek Chin, Francisco Leyva, Paul Foley, Chandrashekhar Kubal, Shajil Chalil, Lakshmi Srinivasan, Lizelle Bernhardt, Suzanne Stevens, Lincoln T. Shenje, Manuel Galiñanes

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background: Studies of the transplantation of autologous bone marrow cells (BMCs) in patients with chronic ischemic heart disease have assessed effects on viable, peri-infarct tissue. We conducted a single-blinded, randomized, controlled study to investigate whether intramuscular or intracoronary administration of BMCs into nonviable scarred myocardium during CABG improves contractile function of scar segments compared with CABG alone. Methods: Elective CABG patients (n = 63), with established myocardial scars diagnosed as akinetic or dyskinetic segments by dobutamine stress echocardiography and confirmed at surgery, were randomly assigned CABG alone (control) or CABG with intramuscular or intracoronary administration of BMCs. The BMCs, which were obtained at the time of surgery, were injected into the mid-depth of the scar in the intramuscular group or via the graft conduit supplying the scar in the intracoronary group. Contractile function was assessed in scar segments by dobutamine stress echocardiography before and 6 months after treatment. Results: The proportion of patients showing improved wall motion in at least one scar segment after BMC treatment was not different to that observed in the control group (P = 0.092). Quantitatively, systolic fractional thickening in scar segments did not improve with BMC administration. Furthermore, BMCs did not improve scar transmurality, infarct volume, left ventricular volume, or ejection fraction. Conclusion: Injection of autologous BMCs directly into the scar or into the artery supplying the scar is safe but does not improve contractility of nonviable scarred myocardium, reduce scar size, or improve left ventricular function more than CABG alone.

Original languageEnglish (US)
Pages (from-to)663-670
Number of pages8
JournalNature Clinical Practice Cardiovascular Medicine
Volume5
Issue number10
DOIs
StatePublished - 2008
Externally publishedYes

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Bone Marrow Cells
Cicatrix
Myocardium
Randomized Controlled Trials
Injections
Stress Echocardiography
Bone Marrow Transplantation
Left Ventricular Function
Myocardial Ischemia
Arteries
Transplants
Control Groups
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Randomized, controlled trial of intramuscular or intracoronary injection of autologous bone marrow cells into scarred myocardium during CABG versus CABG alone. / Ang, Keng Leong; Chin, Derek; Leyva, Francisco; Foley, Paul; Kubal, Chandrashekhar; Chalil, Shajil; Srinivasan, Lakshmi; Bernhardt, Lizelle; Stevens, Suzanne; Shenje, Lincoln T.; Galiñanes, Manuel.

In: Nature Clinical Practice Cardiovascular Medicine, Vol. 5, No. 10, 2008, p. 663-670.

Research output: Contribution to journalArticle

Ang, KL, Chin, D, Leyva, F, Foley, P, Kubal, C, Chalil, S, Srinivasan, L, Bernhardt, L, Stevens, S, Shenje, LT & Galiñanes, M 2008, 'Randomized, controlled trial of intramuscular or intracoronary injection of autologous bone marrow cells into scarred myocardium during CABG versus CABG alone', Nature Clinical Practice Cardiovascular Medicine, vol. 5, no. 10, pp. 663-670. https://doi.org/10.1038/ncpcardio1321
Ang, Keng Leong ; Chin, Derek ; Leyva, Francisco ; Foley, Paul ; Kubal, Chandrashekhar ; Chalil, Shajil ; Srinivasan, Lakshmi ; Bernhardt, Lizelle ; Stevens, Suzanne ; Shenje, Lincoln T. ; Galiñanes, Manuel. / Randomized, controlled trial of intramuscular or intracoronary injection of autologous bone marrow cells into scarred myocardium during CABG versus CABG alone. In: Nature Clinical Practice Cardiovascular Medicine. 2008 ; Vol. 5, No. 10. pp. 663-670.
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AU - Ang, Keng Leong

AU - Chin, Derek

AU - Leyva, Francisco

AU - Foley, Paul

AU - Kubal, Chandrashekhar

AU - Chalil, Shajil

AU - Srinivasan, Lakshmi

AU - Bernhardt, Lizelle

AU - Stevens, Suzanne

AU - Shenje, Lincoln T.

AU - Galiñanes, Manuel

PY - 2008

Y1 - 2008

N2 - Background: Studies of the transplantation of autologous bone marrow cells (BMCs) in patients with chronic ischemic heart disease have assessed effects on viable, peri-infarct tissue. We conducted a single-blinded, randomized, controlled study to investigate whether intramuscular or intracoronary administration of BMCs into nonviable scarred myocardium during CABG improves contractile function of scar segments compared with CABG alone. Methods: Elective CABG patients (n = 63), with established myocardial scars diagnosed as akinetic or dyskinetic segments by dobutamine stress echocardiography and confirmed at surgery, were randomly assigned CABG alone (control) or CABG with intramuscular or intracoronary administration of BMCs. The BMCs, which were obtained at the time of surgery, were injected into the mid-depth of the scar in the intramuscular group or via the graft conduit supplying the scar in the intracoronary group. Contractile function was assessed in scar segments by dobutamine stress echocardiography before and 6 months after treatment. Results: The proportion of patients showing improved wall motion in at least one scar segment after BMC treatment was not different to that observed in the control group (P = 0.092). Quantitatively, systolic fractional thickening in scar segments did not improve with BMC administration. Furthermore, BMCs did not improve scar transmurality, infarct volume, left ventricular volume, or ejection fraction. Conclusion: Injection of autologous BMCs directly into the scar or into the artery supplying the scar is safe but does not improve contractility of nonviable scarred myocardium, reduce scar size, or improve left ventricular function more than CABG alone.

AB - Background: Studies of the transplantation of autologous bone marrow cells (BMCs) in patients with chronic ischemic heart disease have assessed effects on viable, peri-infarct tissue. We conducted a single-blinded, randomized, controlled study to investigate whether intramuscular or intracoronary administration of BMCs into nonviable scarred myocardium during CABG improves contractile function of scar segments compared with CABG alone. Methods: Elective CABG patients (n = 63), with established myocardial scars diagnosed as akinetic or dyskinetic segments by dobutamine stress echocardiography and confirmed at surgery, were randomly assigned CABG alone (control) or CABG with intramuscular or intracoronary administration of BMCs. The BMCs, which were obtained at the time of surgery, were injected into the mid-depth of the scar in the intramuscular group or via the graft conduit supplying the scar in the intracoronary group. Contractile function was assessed in scar segments by dobutamine stress echocardiography before and 6 months after treatment. Results: The proportion of patients showing improved wall motion in at least one scar segment after BMC treatment was not different to that observed in the control group (P = 0.092). Quantitatively, systolic fractional thickening in scar segments did not improve with BMC administration. Furthermore, BMCs did not improve scar transmurality, infarct volume, left ventricular volume, or ejection fraction. Conclusion: Injection of autologous BMCs directly into the scar or into the artery supplying the scar is safe but does not improve contractility of nonviable scarred myocardium, reduce scar size, or improve left ventricular function more than CABG alone.

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