Additional improvement in regional myocardial ischemia after intracardiac injection of bone marrow cells during CABG surgery

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Antonio Carlos Campos de Carvalho¹  José Oscar Reis Brito²  Luiz César Guarita-Souza³  Carlos Eduardo Rochitte⁴  Luís Henrique Wolff Gowdak⁴  Leonardo P. de Carvalho⁴  Luís Alberto Oliveira Dallan⁴  Luiz Antonio Machado César⁴  Isolmar Tadeu Schettert⁴  Jose Eduardo Krieger⁴  Marcelo Luiz Campos Vieira⁴  Sérgio Almeida de Oliveira⁴ 

[1] Cell Technology Center, National Institute of Cardiology, Rio de Janeiro, Brazil;Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;Department of Cardiovascular Surgery, National Institute of Cardiology, Rio de Janeiro, Brazil;Department of Cardiovascular Surgery, Pontifical Catholic University of Paraná, Curitiba, Brazil;Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor-HCFMUSP), University of São Paulo Medical School, São Paulo, Brazil;

关键词: myocardial ischemia;    coronary artery disease;    bone marrow cells;    coronary artery bypass graft surgery (CABG);    cardiovascular magnetic resonance;    stress induced myocardial ischemia;   

DOI  :  10.3389/fcvm.2023.1040188

 received in 2022-09-09, accepted in 2023-01-23,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundPost-procedure residual ischemia is associated with worse prognosis in patients with coronary artery diasease (CAD).ObjectiveWe evaluated whether autologous bone marrow-derived cells (BMC) contribute to additional reduction in regional stress-induced myocardial ischemia (SIMI) in patients undergoing incomplete coronary artery bypass graft surgery (CABG).MethodsIn a double-blind, randomized, placebo-controlled trial, we enrolled 143 patients (82% men, 58 ± 11 years) with stable CAD and not candidates for complete CABG. They received 100 million BMC (n = 77) or placebo (n = 66) injected into ischemic non-revascularized segments during CABG. The primary outcome was improvement on SIMI quantified as the area at risk in injected segments assessed by cardiovascular magnetic resonance (CMR) 1, 6, and 12 months after CABG.ResultsThe reduction in global SIMI after CABG was comparable (p = 0.491) in both groups indicating sustained beneficial effects of the surgical procedure over 12 month period. In contrast, we observed additional improvement in regional SIMI in BMC treated group (p = 0.047). Baseline regional SIMI values were comparable [18.5 (16.2–21.0) vs. 18.5 (16.5–20.7)] and reached the lowest values at 1 month [9.74 (8.25; 11.49) vs. 12.69 (10.84; 14.85)] for BMC and placebo groups, respectively. The ischemia’s improvement from baseline represented a 50% difference in regional SIMI in favor of the BMC transplanted group at 30 days. We found no differences in clinical and LVEF% between groups during the 12 month follow-up period. The 1 month rate of major adverse cerebral and cardiovascular events (MACCE) (p = 0.34) and all-cause mortality (p = 0.08) did not differ between groups 1 month post intervention.ConclusionWe provided evidence that BMC leads to additional reduction in regional SIMI in chronic ischemic patients when injected in segments not subjected to direct surgical revascularization. This adjuvant therapy deserves further assessment in patients with advanced CAD especially in those with microcirculation dysfunction.Clinical trial registrationhttps://clinicaltrials.gov/, identifier NCT01727063

【 授权许可】

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Copyright © 2023 Gowdak, Schettert, Rochitte, de Carvalho, Vieira, Dallan, de Oliveira, César, Brito, Guarita-Souza, de Carvalho and Krieger.