RESYNCHRONIZATION THERAPY IN COMBINATION WITH INTRA-MYOCARDIAL IMPLANTATION OF BONE MARROW STEM CELLS IN PATIENTS WITH HEART FAILURE OF ISCHEMIC ORIGIN AND ELECTROMECHANICAL DYSSYNCHRONY OF THE LEFT VENTRICLE

To assess effectiveness of cardiac resynchronization therapy (CRT) in combination with intra-myocardial transplantation of autologous bone marrow mononuclear stem cells (IABMSCT) in patients with ischemic heart failure, left bundle branch block, and electromechanical dyssynchrony of the left ventricle (LV), 50 patients were examined and surgically treated. The patients were randomized into two groups, each of them consisted of 25 patients. Group 1 received IABMSCT and CRT in the passive mode and Group 2, received IABMSCT and CRT in the active mode. In 6 months, the CRT type was changed in a crossover mode. IABMSCT was performed after the LV mapping. In the area of interest which included damaged (hibernating) but viable myocardium, 10 IABMSCT procedures were carried out. The overall duration of the IABMSCT procedure was 69±22 min, with the X ray exposure of 15±9 min. The total duration of the CRT system implantation was 92±29 min. The 6 minute walk test distance increased during the passive CRT from 206.5±51.7 m to 266.4±79.2 m (p=0.006) and during the active CRT to 389.4±51.6 m (p<0.001 as compared with passive CRT). The functional class of heart failure as per the NYHA classification improved during the active CRT from 3.5±0.5 to 2.1±0.6 (p<0.001) but did not change significantly during the passive CRT. During the active CRT, the heart failure improvement by one functional class occurred in 54% of cases and by two functional classes, in 46%. During the passive CRT, the heart failure severity improved by one functional class in 32% of cases, with no heart failure dynamics in other subjects. The LV ejection fraction during the passive CRT increased from 27.4±2.8^ΰ/ο to 31.3±5.6^ΰ/ο (p<0.02) and during the active CRT, to 43.2±4.1% (p<0.001 as compared with passive CRT). Thus, CRT and IABMSCT independently contributed to elimination of the LV electromechanical dyssynchrony and improvement of myocardial perfusion, respectively. The combination of both techniques can lead to a considerable improvement of clinical and functional state of patients with severe ischemic heart failure and electromechanical dyssynchrony of the LV.

post-infarction cardiosclerosis, ischemic heart failure, autologous bone marrow mononuclear stem cells, intra-myocardial implantation, cardiac resynchronization therapy

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