Predictors of response to intramyocardial bone marrow cell treatment in patients with refractory angina and chronic myocardial ischemia

Sander Rodrigo, Jan Van Ramshorst, Imke Mann, Darryl Leong, Suzanne Cannegieter, Imad Al Younis, Petra Dibbets-Schneider, Albert De Roos, Willem Fibbe, Jaap Zwaginga, Jeroen Bax, Martin Schalij, Saskia Beeres, Douwe Atsma

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    Abstract

    Background We previously showed that intramyocardial bone marrow cell (BMC) injection in patients with refractory angina and chronic myocardial ischemia improves myocardial perfusion, cardiac function and disease-related complaints. Treatment effect varied between patients, but the predictors of response remain to be identified. Therefore, the aim of the present study was to assess whether patient characteristics, procedural data and baseline measurements influence the response to intramyocardial BMC treatment in a large cohort of refractory angina patients. Methods and results In 120 patients (64 ± 9 years, 88% men) with refractory angina, 97 ± 13 × 106 BMCs were injected intramyocardially in regions with stress-inducible ischemia as assessed by single photon emission computed tomography (SPECT). Canadian Cardiovascular Society angina (CCS) class, quality-of-life score, exercise testing, SPECT and magnetic resonance imaging were performed at baseline and at 3 months follow-up demonstrating significant improvements in CCS class, quality-of-life, exercise capacity, myocardial perfusion and left ventricular function (all variables P < 0.001). Multivariate analysis was performed to evaluate the influence of patient characteristics, procedural data and baseline measurements on BMC treatment response. Based on the improvement of myocardial perfusion at stress, diabetes and a large number of ischemic segments at baseline were shown to be independently associated with a large response to BMC therapy. Conclusion The present study demonstrates that diabetes and a large number of ischemic segments are predictors of a large response to intramyocardial BMC injection in refractory angina and chronic ischemia. Furthermore, the safety and efficacy results of previous trials are now confirmed in a larger study population.

    Original languageEnglish
    Pages (from-to)539-544
    Number of pages6
    JournalInternational Journal of Cardiology
    Volume175
    Issue number3
    DOIs
    Publication statusPublished - 2014

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  • Cite this

    Rodrigo, S., Van Ramshorst, J., Mann, I., Leong, D., Cannegieter, S., Al Younis, I., Dibbets-Schneider, P., De Roos, A., Fibbe, W., Zwaginga, J., Bax, J., Schalij, M., Beeres, S., & Atsma, D. (2014). Predictors of response to intramyocardial bone marrow cell treatment in patients with refractory angina and chronic myocardial ischemia. International Journal of Cardiology, 175(3), 539-544. https://doi.org/10.1016/j.ijcard.2014.06.039