Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital.
Department of Cardiothoracic Surgery, Heart and Lung Center, Helsinki University Central Hospital.
J Heart Lung Transplant. 2015 Jul;34(7):899-905. doi: 10.1016/j.healun.2015.01.989. Epub 2015 Feb 7.
Long-term results regarding treatment of chronic ischemic heart failure with bone marrow mononuclear cells (BMMCs) have been few. We received encouraging results at the 1-year follow-up of patients treated with combined coronary artery bypass grafting (CABG) and BMMCs, so we decided to extend the follow-up.
The study patients had received injections of BMMCs or vehicle into the myocardial infarction border area during CABG in a randomized and double-blind manner. We could contact 36 of the 39 patients recruited for the original study. Pre-operatively and after an extended follow-up period, we performed magnetic resonance imaging, measured pro-B-type amino-terminal natriuretic peptide, reviewed patient records from the follow-up period, and determined current quality of life with the Medical Outcomes Study Short-Form 36 (SF-36) Health Survey.
The median follow-up time was 60.7 months (interquartile range [IQR], 45.1-72.6 months). No statistically significant difference was detected in change of pro-B-type amino-terminal natriuretic peptide values or in quality of life between groups. The median change in left ventricular ejection fraction was 4.9% (IQR, -2.1% to 12.3%) for controls and 3.9% (IQR, -5.2% to 10.2%) for the BMMC group (p = 0.647). Wall thickening in injected segments increased by a median of 17% (IQR, -5% to 30%) for controls and 15% (IQR, -12% to 19%) for BMMC patients (p = 0.434). Scar size in injected segments increased by a median of 2% (IQR, -7% to 19%) for controls but diminished for BMMC patients, with a median change of -17% (IQR, -30% to -6%; p = 0.011).
In the treatment of chronic ischemic heart failure, combining intramyocardial BMMC therapy with CABG fails to affect cardiac function but can sustainably reduce scar size, even in the long-term.
骨髓单个核细胞（BMMC）治疗慢性缺血性心力衰竭的长期结果数据较少。我们在接受联合冠状动脉旁路移植术（CABG）和 BMMC 治疗的患者的 1 年随访中获得了令人鼓舞的结果，因此我们决定延长随访时间。
研究患者在 CABG 期间以随机和双盲的方式接受 BMMC 或载体注射到心肌梗死边界区。我们可以联系到原始研究中招募的 39 名患者中的 36 名。在术前和延长的随访期间，我们进行了磁共振成像检查，测量了脑利钠肽前体（pro-B-type amino-terminal natriuretic peptide），回顾了随访期间的病历，并使用医疗结局研究短表 36 健康调查（Medical Outcomes Study Short-Form 36，SF-36）确定当前的生活质量。
中位随访时间为 60.7 个月（四分位距 [IQR]，45.1-72.6 个月）。两组之间 pro-B-type amino-terminal natriuretic peptide 值或生活质量的变化无统计学差异。对照组左心室射血分数的中位数变化为 4.9%（IQR，-2.1%至 12.3%），BMMC 组为 3.9%（IQR，-5.2%至 10.2%）（p = 0.647）。注射段的壁增厚中位数增加了 17%（IQR，-5%至 30%），对照组为 15%（IQR，-12%至 19%）（p = 0.434）。对照组注射段的疤痕大小中位数增加了 2%（IQR，-7%至 19%），但 BMMC 患者的疤痕大小中位数减少了 17%（IQR，-30%至-6%；p = 0.011）。
在慢性缺血性心力衰竭的治疗中，将 BMMC 心肌内治疗与 CABG 相结合并不能影响心功能，但可以持续减少疤痕大小，即使在长期随访中也是如此。
