State Research Institute of Circulation Pathology, Novosibirsk, Russia.
J Cardiovasc Transl Res. 2011 Dec;4(6):767-78. doi: 10.1007/s12265-011-9283-1. Epub 2011 May 6.
Most studies have confirmed the beneficial effects of autologous bone marrow mononuclear cell (BMMC) transplantation on angina, myocardial perfusion, regional wall motion, and LV ejection fraction (LVEF). Cardiac resynchronization therapy (CRT) has also shown a beneficial effect in patients with heart failure (HF) and electrical/mechanical dyssynchrony. However, the relative contribution of BMMC and CRT in patients with ischemic HF and electromechanical dyssynchrony has never been investigated. The aim of this study was to evaluate the benefit of combining BMMC transplantation with CRT in patients with severe ischemic HF, left bundle branch block (LBBB), and mechanical dyssynchrony. Patients with ischemic HF, LVEF < 35%, LBBB, and mechanical dyssynchrony underwent intramyocardial transplantation of BMMC and CRTD system implantation. This randomized, single-blind, crossover study compared clinical and echocardiographic parameters during two follow-up periods: 6 months of active CRT (BMMC + CRTact) and 6 months of inactive CRT (BMMC + CRTinact). Physical performance was assessed by means of a 6-min walking test. Myocardial perfusion was evaluated by SPECT. Quality of Life (QoL) was assessed through the Minnesota Living with HF Questionnaire (MLwHFQ). Twenty-six patients (64 ± 7 years) were enrolled in the study. The distance covered by the patients during the 6-min walking test significantly increased in the BMMC + CRTinact phase (BMMC therapy only) in comparison with the baseline (269 ± 68 vs 206 ± 51; p = 0.007) and in the BMMC + CRTact phase (BMMC therapy + CRT) in comparison with the BMMC + CRTinact (378 ± 59 vs 269 ± 68; p < 0.001). The summed rest and stress score (SPECT) decreased significantly in the BMMC + CRTact and BMMC + CRTinact phases in comparison with the baseline (p ≤ 0.03). Both phases showed equivalent myocardial perfusion in the segments into which BMMC had been injected. QoL score was significantly lower in the BMMC + CRTinact phase than at the baseline (44.1 ± 14 vs 64.8 ± 19; p < 0.001), and in the BMMC + CRTact phase than in the BMMC + CRTinact phase (26.4 ± 12 vs 44.1 ± 14; p = 0.004). BMMC and CRT seem to act independently on myocardial perfusion and electromechanical dyssynchrony, respectively. Combining these two complementary therapies can significantly improve LV performance in patients with severe HF and electromechanical dyssynchrony.
大多数研究证实了自体骨髓单个核细胞（BMMC）移植对心绞痛、心肌灌注、局部壁运动和左心室射血分数（LVEF）的有益作用。心脏再同步治疗（CRT）也已显示出对心力衰竭（HF）和电/机械不同步患者的有益作用。然而，BMMC 和 CRT 在缺血性 HF 和电机械不同步患者中的相对贡献从未被研究过。本研究旨在评估在严重缺血性 HF、左束支传导阻滞（LBBB）和机械不同步患者中联合 BMMC 移植与 CRT 的益处。患有缺血性 HF、LVEF<35%、LBBB 和机械不同步的患者接受了 BMMC 的心肌内移植和 CRT 系统植入。这是一项随机、单盲、交叉研究，比较了两个随访期的临床和超声心动图参数：6 个月的主动 CRT（BMMC+CRTact）和 6 个月的不活动 CRT（BMMC+CRTinact）。通过 6 分钟步行测试评估身体表现。心肌灌注通过 SPECT 评估。生活质量（QoL）通过明尼苏达州心力衰竭生活问卷（MLwHFQ）评估。26 名患者（64±7 岁）入组本研究。与基线相比，在 BMMC+CRTinact 期（仅 BMMC 治疗）患者在 6 分钟步行测试中覆盖的距离明显增加（269±68 比 206±51；p=0.007），在 BMMC+CRTact 期（BMMC 治疗+CRT）与 BMMC+CRTinact 期相比也有所增加（378±59 比 269±68；p<0.001）。与基线相比，BMMC+CRTact 和 BMMC+CRTinact 期的静息和应激总和评分（SPECT）均显著降低（p≤0.03）。在注入 BMMC 的节段中，两种阶段均显示出等效的心肌灌注。与基线相比，BMMC+CRTinact 期的 QoL 评分明显较低（44.1±14 比 64.8±19；p<0.001），与 BMMC+CRTact 期相比也较低（26.4±12 比 44.1±14；p=0.004）。BMMC 和 CRT 似乎分别独立作用于心肌灌注和电机械不同步。联合这两种互补疗法可显著改善严重 HF 和电机械不同步患者的 LV 功能。
