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October 16, 2006
By
Sahar
Bedrood B.S. and Asher Kimchi M.D.
Oslo, Norway-
The net loss of cardiomyocytes during myocardial
infarction is a key factor in the impairment of
cardiac-pump function. The bone marrow contains stem
cells that have shown promising results in
solid-organ repair and regeneration. Ketil Lunde
M.D. et al from the Rikshospitalet University
Hospital in Oslo, Norway designed a randomized,
controlled trial to investigate the effects of
intracoronary injection of autologous cells from
bone marrow (BMC) in the acute phase of myocardial
infarction. They investigated whether there was any
improvement in left ventricular function after the
treatment. The study, published in the September 21,
2006 issue of The New England Journal of Medicine,
found no effects of intracoronary injection of
autologous mononuclear BMC on global left
ventricular function.
Patients
with acute ST-elevation myocardial infarction of the anterior
wall treated with percutanous coronary intervention were
randomly assigned to the group that underwent intracoronary
injection of autologous mononuclear BMC or the control group. No
aspiration or sham injection was performed in the control
group. Left ventricular function was assessed with the use of
electrocardiogram-gated single-photon emission computed
tomography (SPECT) and echocardiography at baseline and magnetic
resonance imaging (MRI) 2 to 3 weeks after the infarction. These
procedures were repeated 6 months after the infarction. End
points were changes in the left ventricular ejection fraction (LVEF),
end-diastolic volume, and infarct size.
The trial
had 47 patients undergo intracoronary injection of the
mononuclear bone marrow cells at a median of 6 days after
myocardial infarction. There were 50 patients in the control
group. The mean change in LVEF between baseline and 6 months
after infarction for all patients was 7.6 +/- 10.4 percentage
points. The effect of BMC treatment on the change in LVEF was an
increase of 0.6 percentage point (95% confidence interval, -3.4%
to 4.6; P=0.77) on SPECT, an increase of 0.6 percentage point
(95% confidence interval, -2.6 to 3.8; P=0.70) on
echocardiography, and a decrease of 3.0 percentage points (95%
confidence interval, 0.1 to –6.1; P= 0.054) on MRI. The two
groups did not differ significantly in changes in left
ventricular end-diastolic volume or infarct size.
The study
concluded they found no effects of intracoronary injection of
autologous mononuclear BMC on global left ventricular function.
Co-authors:
Ketil Lunde, M.D., Svein Solheim, M.D., Svend Aakhus, M.D.,
Ph.D., Harald Arnesen, M.D., Ph.D., Michael Abdelnoor, Ph.D.,
Torstein Egeland, M.D., Ph.D., Knut Endresen, M.D., Ph.D.,
Arnfinn Ilebekk, M.D., Ph.D., Arild Mangschau, M.D., Ph.D., Jan
G. Fjeld, M.D., Ph.D., Hans Jørgen Smith, M.D., Ph.D., Eli
Taraldsrud, M.D., Haakon Kiil Grøgaard, M.D., Reidar Bjørnerheim,
M.D., Ph.D., Magne Brekke, M.D., Carl Müller, M.D., Einar Hopp,
M.D., Asgrimur Ragnarsson, M.D., Jan E. Brinchmann, M.D., Ph.D.,
and Kolbjørn Forfang, M.D., Ph.D.
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