Cell therapy for severe chronic heart failure: The Luxembourg experience

Intracoronary infusion of autologous bone marrow cells (CTX) has been shown to improve myocardial function in post infarct patients and in patients with chronic ischemic cardiomyopathy. Whether CTX affects exercise-induced changes in cardiac deformation and mitral regurgitation (MR) in patients with end stage heart failure has not been studied. In this small pilot study, eleven patients with chronic ischemic cardiomyopathy, ejection fraction (EF) <25%, no inducible ischemia and heart failure class NYHA III underwent CTX. Symptom-limited bicycle exercise echocardiography was performed pre- and 4 months post CTX and maximum systolic strain (msyε), peak systolic strain rate (psysr) and effective regurgitant orifice of MR (ERO) were determined. There were no complications related to the procedure. The overall clinical benefit of CTX was limited with a trend towards improvement (NYHA 3.0±0.1 pre and 2.7±0.2 post CTX, p=0.06). The EF did not improve after CTX. The wall motion score index (WMSI) did not change at rest but decreased significantly during exercise (1.48±0.16 vs. 1.44±0.17, p=0.01). In conclusion, CTX may improve cardiac deformation and MR during exercise in patients with severe chronic heart failure when viable areas are targeted.