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Improvement of exercise-induced cardiac deformation after cell therapy for severe chronic ischemic heart failure
Frederic Lebrun1, Guy Berchem, Charles Delagardelle
1Division of Cardiology, Centre Hospitalier Luxembourg, Centre de Recherche Public Santé, 4 rue Barblé, L-1210 Luxembourg.
Insights
Autologous bone marrow cell infusion (CTX) showed limited clinical benefit in end-stage heart failure. However, CTX improved exercise-induced cardiac function and reduced mitral regurgitation in patients with viable heart muscle areas.
Area of Science:
- Cardiology
- Regenerative Medicine
- Cardiac Imaging
Background:
- Intracoronary autologous bone marrow cells (CTX) improve myocardial function in post-infarct and chronic ischemic cardiomyopathy patients.
- The effect of CTX on exercise-induced cardiac deformation and mitral regurgitation (MR) in end-stage heart failure is unstudied.
Purpose of the Study:
- To investigate the impact of CTX on exercise-induced cardiac deformation and MR in patients with end-stage heart failure.
Main Methods:
- A pilot study involving 11 patients with chronic ischemic cardiomyopathy (ejection fraction <25%, NYHA class III) who underwent CTX.
- Symptom-limited bicycle exercise echocardiography was performed pre- and 4 months post-CTX.
- Evaluated maximum systolic strain (msyepsilon), peak systolic strain rate (psysr), and effective regurgitant orifice of MR (ERO).
Main Results:
- No procedural complications occurred.
- Overall clinical benefit was limited, with a trend towards improvement in heart failure class (NYHA). Ejection fraction did not improve.
- Wall motion score index decreased significantly during exercise.
- In patients with viable myocardial areas, msyepsilon and psysr increased during exercise, and ERO decreased, particularly with inferior viability. These effects were not observed in non-viable areas or at rest.
Conclusions:
- CTX may enhance exercise-induced cardiac deformation and reduce MR in severe chronic heart failure patients.
- Targeting viable myocardial areas appears crucial for achieving these benefits.
Background:
Intracoronary infusion of autologous bone marrow cells (CTX) has been shown to improve myocardial function in postinfarct patients and in patients with chronic ischemic cardiomyopathy. Whether CTX affects exercise-induced changes in cardiac deformation and mitral regurgitation (MR) in patients with end-stage heart failure has not been studied.
Methods And Results:
In this small pilot study, 11 patients with chronic ischemic cardiomyopathy, ejection fraction (EF) <25%, no inducible ischemia and heart failure class New York Heart Association (NYHA) III underwent CTX. Symptom-limited bicycle exercise echocardiography was performed pre- and 4 months post-CTX and maximum systolic strain (msyepsilon), peak systolic strain rate (psysr), and effective regurgitant orifice of MR (ERO) were determined. There were no complications related to the procedure. The overall clinical benefit of CTX was limited with a trend towards improvement (NYHA 3.0 +/- 0.1 pre- and 2.7 +/- 0.2 post-CTX, P = .06). The EF did not improve after CTX. The wall motion score index did not change at rest but decreased significantly during exercise (1.48 +/- 0.16 versus 1.44 +/- 0.17, P = .01). In patients with non-viable areas, msyepsilon, psysr, and ERO were not affected by CTX. However, in patients with viable areas, msyepsilon and psysr appeared to increase during exercise and ERO appeared to decrease from 19 +/- 5 to 16 +/- 5 mm(2). This effect was not apparent at rest and more pronounced with inferior viability.
Conclusion:
CTX may improve cardiac deformation and MR during exercise in patients with severe chronic heart failure when viable areas are targeted.
