Long-term results of autologous stem cell transplantation in the treatment of patients with congestive heart failure.

BACKGROUND

The aim of this study was to assess the long-term efficacy of stem cell transplantation with revascularization for patients with ischemic cardiomyopathy.

METHODS

We enrolled 17 patients with ischemic cardiomyopathy who had undergone autologous stem cell treatment. To assess myocardial ischemia and viability they underwent coronary angiography, stress tests with dobutamine, echocardiography, and positron emission tomography. Peripheral stem cells mobilized using granulocyte colony-stimulating factor (G-CSF) were collected by aphseresis for transplantation transmyocardially into the areas of injury during coronary artery bypass surgery to increase blood flow to the engrafted areas.

RESULTS

Three patients died in the early follow-up period and 4 patients with cardiac failure died during mid-term follow-up; they all underwent stem cell transplantation at 6 months after acute myocardial infarction. The mean follow-up period of the remaining 10 patients was 85.8 ± 9.2 months (range, 70-100). Mean left ventricular ejection fraction improved to 30.0 ± 6.7, whereas the preoperative mean left ventricular ejection fraction of the surviving patients was 25.6 ± 4.5 (P = .035). Mean New York Heart Association (NYHA) functional class decreased from 3.2 to 1.5 (P = .006). When the study population was divided into 2 subgroups according to the interval between acute myocardial infraction and surgery, the patients who underwent autologous stem cell transplantation within the first 6 months after myocardial infraction (Group 1) showed significantly lower NYHA scores at the last follow-up (P = .024 in Group 1 and P = .102 in Group 2). No side effects were observed to be due to the stem cell or G-CSF injections.

CONCLUSION

Treatment of ischemic cardiomyopathy with autologous stem cell transplantation is easy and safe, opening a new window in the treatment of "no hope" patients.