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Updated: Mar 13, 2026
Intramyocardial Cell Delivery: Observations in Murine Hearts
Published on: January 24, 2014
Long-Term Outcome of Combined (Percutaneous Intramyocardial and Intracoronary) Application of Autologous Bone Marrow
Mariann Gyöngyösi1, Georgiana-Aura Giurgea2, Bonni Syeda1
1Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Insights
Early or late delivery of autologous bone marrow mononuclear cells (BM-MNCs) after acute myocardial infarction (AMI) showed sustained cardiac function improvement over 5 years. This cell therapy is safe and feasible for patients with reduced ejection fraction post-AMI.
Area of Science:
- Cardiology
- Regenerative Medicine
- Cell Therapy
Background:
- Acute myocardial infarction (AMI) can lead to significantly reduced left ventricular ejection fraction (LVEF).
- Bone marrow mononuclear cells (BM-MNCs) are being investigated for their potential to repair cardiac tissue post-AMI.
- Optimizing the timing of BM-MNC delivery is crucial for long-term therapeutic efficacy.
Purpose of the Study:
- To evaluate the 5-year outcome of early versus late combined intramyocardial and intracoronary delivery of autologous BM-MNCs in patients with post-AMI ejection fractions between 30-45%.
- To assess the safety and long-term efficacy of BM-MNC therapy in improving cardiac function and reducing adverse events.
Main Methods:
- A total of 120 patients with post-AMI EF 30-45% were randomized into early (3-6 weeks) or late (3-4 months) BM-MNC treatment groups.
- Combined percutaneous intramyocardial and intracoronary delivery of autologous BM-MNCs was performed.
- Major adverse cardiac and cerebrovascular events (MACCE), hospitalizations, and ventricular function (LVEF, RVÉF) were monitored over 5 years using echocardiography, MRI, and SPECT.
- Myocardial viability was assessed by NOGA mapping and correlated with outcomes.
Main Results:
- No significant difference in 5-year MACCE incidence or composite adverse events between early and late treatment groups.
- Sustained significant improvement in LVEF from baseline to 5 years was observed in both groups (approx. 5.5% increase), with no significant change between 1 and 5 years.
- Significant increase in right ventricular ejection fraction (RVEF) from baseline to 5 years in both groups.
- Lower baseline myocardial viability in treated areas correlated with higher MACCE incidence.
Conclusions:
- Combined percutaneous delivery of autologous BM-MNCs is a feasible and safe 5-year treatment strategy for patients with low EF post-AMI.
- The therapy demonstrates sustained improvement in cardiac function (LVEF and RVEF) at the 5-year follow-up.
- Timing of BM-MNC delivery (early vs. late) did not significantly impact long-term clinical outcomes or cardiac function.
Objective:
The long-term (5-year) outcome of early (3-6 weeks after acute myocardial infarction [AMI], BM-MNC Early group) and late (3-4 months after AMI, BM-MNC Late group) combined (percutaneous intramyocardial and intracoronary) delivery of autologous bone marrow mononuclear cells (BM-MNCs) was evaluated in patients with ejection fractions (EF) between 30-45% post-AMI.
Methods:
Major adverse cardiac and cerebrovascular events (MACCE) and hospitalization were recorded. Left (LV) and right (RV) ventricular function were measured by transthoracic echocardiography. Cardiac magnetic resonance imaging (MRI) and myocardial single photon emission computed tomography was performed in a subgroup of patients. Pre-cell therapy myocardial voltage values of treated areas (assessed by NOGA mapping) were correlated with clinical outcome.
Results:
Five-year MACCE incidences (7.4%. vs 24.1%) and the composite of all adverse events (11.1% vs 27.6%) were not different between the Early and Late treatment groups. The significant LV-EF increase at 1-year follow-up was preserved at the 5-year control (from baseline to 5-year: 5.3%, 95% CI:0.5-10.1, and 5.7%, 95% CI:1.7-9.6, p<0.05 in the Early and Late groups, respectively), with no significant changes between 1- and 5-year follow-ups. Similarly, RVEF increased significantly from baseline to the 5-year follow-up (Early group: 5.4%, 95% CI:1.0-9.6; and Late group: 8.4%, 95% CI:4.5-12.3). Lower baseline levels of myocardial viability of the treated cardiac area (6.3±2.4 vs 8.2±3.0 mV, p<0.05) were associated with incidence of MACCE.
Conclusions:
Percutaneous combined delivery of autologous BM-MNCs is feasible and safe after 5 years, and may result in sustained improvement of cardiac function at 5 years in patients with low EF post-AMI (Clinicaltrials.gov NCT01395212).
