Transendocardial, autologous bone marrow cell transplantation for severe, chronic XXXX .

@entity1 @entity712 @entity2295 @entity741 @entity1011
BACKGROUND: This study evaluated the hypothesis that transendocardial injections of autologous mononuclear bone marrow cells in @entity1 with end-stage @entity741 could safely promote @entity2295 and improve perfusion and myocardial contractility. METHODS AND RESULTS: Twenty-one @entity1 were enrolled in this prospective, nonrandomized, open-label study (first 14 @entity1 , treatment; last 7 @entity1 , control). Baseline evaluations included complete clinical and laboratory evaluations, exercise stress (ramp treadmill), 2D Doppler echocardiogram, single-photon emission computed tomography perfusion scan, and 24-hour Holter monitoring. Bone marrow mononuclear cells were harvested, isolated, washed, and resuspended in saline for injection by NOGA catheter (15 injections of 0.2 cc). Electromechanical mapping was used to identify viable myocardium (unipolar voltage > or =6.9 mV) for treatment. Treated and control @entity1 underwent 2-month noninvasive follow-up, and treated @entity1 alone underwent a 4-month invasive follow-up according to standard protocols and with the same procedures used as at baseline. @entity1 population demographics and exercise test variables did not differ significantly between the treatment and control groups; only serum @entity1011 and brain natriuretic peptide levels varied in laboratory evaluations at follow-up, being relatively higher in control @entity1 . At 2 months, there was a significant reduction in total reversible defect and improvement in global left ventricular function within the treatment group and between the treatment and control groups (P=0.02) on quantitative single-photon emission computed tomography analysis. At 4 months, there was improvement in ejection fraction from a baseline of 20% to 29% (P=0.003) and a reduction in end-systolic volume (P=0.03) in the treated @entity1 . Electromechanical mapping revealed significant mechanical improvement of the injected segments (P<0.0005) at 4 months after treatment. CONCLUSIONS: Thus, the present study demonstrates the relative safety of intramyocardial injections of bone marrow-derived stem cells in @entity1 with severe @entity712 and the potential for improving myocardial blood flow with associated enhancement of regional and global left ventricular function.
