Trans-endocardial delivery of progenitor cells to compromised myocardium using the "needle technique"and risk of myocardial injury.

Abstract

Introduction:

Recent analysis from CHART-1 study indicated that the therapeutic effects of trans-endocardial cardiopoetic cell transplantation in chronic ischemic heart failure (iCHF) may be lost with an increasing number of injections perfomed to deliver therapeutic cells.

Aim:

To evaluate global and regional contractility and diastolic function of the left ventricle of patients with iCHF who received trans-endomyocardial cardiopoietic stem cells (CSCs) delivery or sham procedures.

Material and methods:

The study included patients (mean age: 60.8 ±7.1 years) with iCHF (left ventricular ejection fraction (LVEF) < 35%) and a history of hospitalization for worsening heart failure within 12 months despite optimal medical therapy. The patients underwent transmyocardial CSCs transplantation using perforated needle technique or a sham procedure. The wall motion score index (WMSI), LVEF, transmitral E-velocity, E-wave deceleration time, E/A-ratio, and E/e'-mean value were measured with two-dimensional echocardiography on days 1 and 30.

Results:

A total of 170 segments were analyzed, including 48 targeted segments where 92 injections of 0.5 ml of CSCs were performed. In the transendocardial injections cohort, a decrease in regional contractility was observed in 30.6% (26/85) and 18.9% (16/85) of the segments on days 1 and 30, respectively. This was accompanied by an increase in WMSI by 0.32 ±0.06 and 0.19 ±0.18 (day 1, p = 0.02, day 30, p = 0.03) and a reduction in LVEF (-3.15 ±1.23%, p = 0.065).

Conclusions:

Transendocardial injections performed to deliver therapeutic cells were associated with myocardial injury. This adverse effect remained, albeit at a lesser degree, at 30-days. Mechanical injury with trans-endocardial delivery of progenitor cells using the "needle technique" may counterbalance, at least in part, any cell-related benefit(s).

• Authors: Leszek Drabik, Adam Mazurek, Monika Dzieciuch-Rojek, Lukasz Tekieli, Łukasz Czyż, Ewa Kwiecień, Aleksandra Kułaga, Aleksandra Mikunda, Jakub Chmiel, Wojciech Płazak, Paweł Rubiś, Piotr Musiałek
• Journal: Postepy w kardiologii interwencyjnej = Advances in interventional cardiology (Postepy Kardiol Interwencyjnej) Vol. 18 Issue 4 Pg. 423-430 (Dec 2022) ISSN: 1734-9338 [Print] Poland
• PMID: 36967845 (Publication Type: Journal Article)
• Copyright: Copyright: © 2022 Termedia Sp. z o. o.