The autologous bone marrow mononuclear cell transplantation by intracoronary route treat patients with severe heart failure after myocardial infarction

Objective To investigate the chronic effects of intracoronary autologous bone marrow mononuclear cell (BM-MNCs) transplantation in patients with refractory heart failure (RIHF) after myocardial infarction. Methods Thirty patients with RIHF (LVEF40%) were enrolled in this nonrandomized study, autologous BM-MNCs (5.0±0. 7)×107 were transplanted with via infarct-related coronary artery in 16 patients and 14 patients received standard medical therapy served as control. Baseline and follow up evaluations included complete clinical evaluations, plasma BNP, ANP, ET-1 measurements, echocardiography, PET, and Holter monitoring. Results Baseline characteristics were similar between the 2 groups. There were no major periprocedural complications. One patient developed ventricular premature contractions during cell infusion for several seconds and recovered pontaneously. Compared to pre-transplantation, plasma BNP and ET-1 significantly decreased and plasma ANP significantly increased at 7 days post transplantation; 6 minutes walking distance increased from (72.1±31.5) to (201.6±23.3) m (P0.01), LVEF increased 9.9% (P0.001) and FDG-PET revealed vital myocardium area increased (10.3±3.4)% (P0.01) at 3 months after BM-MNCs transplantation. At 6 months follow up, the NYHA class improved from (3.4±0.1 to 2.4±0.2, P0.001) and no patient died and 1 patient rehospitalized due to lower extremities edema. In control group, LVEF decreased 7.2% compared to baseline (P0.001) and was significantly lower than transplantation group at 3 months (P0.001). At 6 months follow up, the NYHA class increased from (3. 5±0.1 to 3.9±0.1, P0.05) , 2 patients died and 10 patients rehospitalized due to aggravated heart failure. Conclusion Present study demonstrates that intracoronary transplantation of autologous BM-MNCs is safe and effective for treating patients with RIHF after myocardial infarction.