Cardiac Resynchronization Therapy and Bone Marrow Cell Transplantation in Patients with Ischemic Heart Failure and Electromechanical Dyssynchrony: A Randomized Pilot Study
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 hea...
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| Veröffentlicht in: | Journal of cardiovascular translational research 2011-12, Vol.4 (6), p.767-778 |
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| creator | Pokushalov, Evgeny Romanov, Alexander Corbucci, Giorgio Prohorova, Darya Chernyavsky, Alexander Larionov, Petr Terekhov, Igor Artyomenko, Sergey Kliver, Elena Shirokova, Natalya Karaskov, Alexander Dib, Nabil |
| description | 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 |
| doi_str_mv | 10.1007/s12265-011-9283-1 |
| format | Article |
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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.</description><identifier>ISSN: 1937-5387</identifier><identifier>EISSN: 1937-5395</identifier><identifier>DOI: 10.1007/s12265-011-9283-1</identifier><identifier>PMID: 21547598</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Aged ; Biomedical Engineering and Bioengineering ; Biomedicine ; Bone Marrow Transplantation - adverse effects ; Bundle-Branch Block - diagnosis ; Bundle-Branch Block - etiology ; Bundle-Branch Block - physiopathology ; Bundle-Branch Block - therapy ; Cardiac Resynchronization Therapy - adverse effects ; Cardiology ; Chi-Square Distribution ; Combined Modality Therapy ; Coronary Circulation ; Cross-Over Studies ; Echocardiography, Doppler ; Exercise Test ; Female ; Heart Failure - diagnosis ; Heart Failure - etiology ; Heart Failure - physiopathology ; Heart Failure - therapy ; Human Genetics ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Myocardial Ischemia - complications ; Myocardial Ischemia - diagnosis ; Myocardial Ischemia - physiopathology ; Myocardial Ischemia - therapy ; Myocardial Perfusion Imaging - methods ; Pilot Projects ; Predictive Value of Tests ; Quality of Life ; Recovery of Function ; Russia ; Single-Blind Method ; Stroke Volume ; Surveys and Questionnaires ; Time Factors ; Tomography, Emission-Computed, Single-Photon ; Treatment Outcome ; Ventricular Dysfunction, Left - diagnosis ; Ventricular Dysfunction, Left - etiology ; Ventricular Dysfunction, Left - physiopathology ; Ventricular Dysfunction, Left - therapy ; Ventricular Function, Left</subject><ispartof>Journal of cardiovascular translational research, 2011-12, Vol.4 (6), p.767-778</ispartof><rights>Springer Science+Business Media, LLC 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c343t-f10b5e30ae7dd37183ba114e0a3cf495bd1c920e4c740d1ea0ab62583b1995053</citedby><cites>FETCH-LOGICAL-c343t-f10b5e30ae7dd37183ba114e0a3cf495bd1c920e4c740d1ea0ab62583b1995053</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12265-011-9283-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12265-011-9283-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21547598$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pokushalov, Evgeny</creatorcontrib><creatorcontrib>Romanov, Alexander</creatorcontrib><creatorcontrib>Corbucci, Giorgio</creatorcontrib><creatorcontrib>Prohorova, Darya</creatorcontrib><creatorcontrib>Chernyavsky, Alexander</creatorcontrib><creatorcontrib>Larionov, Petr</creatorcontrib><creatorcontrib>Terekhov, Igor</creatorcontrib><creatorcontrib>Artyomenko, Sergey</creatorcontrib><creatorcontrib>Kliver, Elena</creatorcontrib><creatorcontrib>Shirokova, Natalya</creatorcontrib><creatorcontrib>Karaskov, Alexander</creatorcontrib><creatorcontrib>Dib, Nabil</creatorcontrib><title>Cardiac Resynchronization Therapy and Bone Marrow Cell Transplantation in Patients with Ischemic Heart Failure and Electromechanical Dyssynchrony: A Randomized Pilot Study</title><title>Journal of cardiovascular translational research</title><addtitle>J. of Cardiovasc. Trans. Res</addtitle><addtitle>J Cardiovasc Transl Res</addtitle><description>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.</description><subject>Aged</subject><subject>Biomedical Engineering and Bioengineering</subject><subject>Biomedicine</subject><subject>Bone Marrow Transplantation - adverse effects</subject><subject>Bundle-Branch Block - diagnosis</subject><subject>Bundle-Branch Block - etiology</subject><subject>Bundle-Branch Block - physiopathology</subject><subject>Bundle-Branch Block - therapy</subject><subject>Cardiac Resynchronization Therapy - adverse effects</subject><subject>Cardiology</subject><subject>Chi-Square Distribution</subject><subject>Combined Modality Therapy</subject><subject>Coronary Circulation</subject><subject>Cross-Over Studies</subject><subject>Echocardiography, Doppler</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - etiology</subject><subject>Heart Failure - physiopathology</subject><subject>Heart Failure - therapy</subject><subject>Human Genetics</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Myocardial Ischemia - complications</subject><subject>Myocardial Ischemia - diagnosis</subject><subject>Myocardial Ischemia - physiopathology</subject><subject>Myocardial Ischemia - therapy</subject><subject>Myocardial Perfusion Imaging - methods</subject><subject>Pilot Projects</subject><subject>Predictive Value of Tests</subject><subject>Quality of Life</subject><subject>Recovery of Function</subject><subject>Russia</subject><subject>Single-Blind Method</subject><subject>Stroke Volume</subject><subject>Surveys and Questionnaires</subject><subject>Time Factors</subject><subject>Tomography, Emission-Computed, Single-Photon</subject><subject>Treatment Outcome</subject><subject>Ventricular Dysfunction, Left - diagnosis</subject><subject>Ventricular Dysfunction, Left - etiology</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><subject>Ventricular Dysfunction, Left - therapy</subject><subject>Ventricular Function, Left</subject><issn>1937-5387</issn><issn>1937-5395</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhiMEoqXwA7gg3zgF_BGv19zK0i-piKosZ2vizBJXib3Yjqr0L_En65K2R04z0jzzjkZPVb1n9BOjVH1OjPOVrCljteZrUbMX1SHTQtVSaPnyuV-rg-pNSjeUrjhV6nV1wJlslNTrw-rvBmLnwJJrTLO3fQze3UF2wZNtjxH2MwHfka_BI_kOMYZbssFhINsIPu0H8HmBnSdXpUOfE7l1uScXyfY4OkvOEWImp-CGKeK_sJMBbY5hRNuDdxYG8m1OT9fnL-SYXBcsjO4OO3LlhpDJzzx189vq1Q6GhO8e61H16_RkuzmvL3-cXWyOL2srGpHrHaOtREEBVdcJxdaiBcYapCDsrtGy7ZjVnGJjVUM7hkChXXFZMKa1pFIcVR-X3H0MfyZM2Ywu2fI1eAxTMprKlaKK60KyhbQxpBRxZ_bRjRBnw6h5UGQWRaYoMg-KDCs7Hx7Tp3bE7nnjyUkB-AKkMvK_MZqbMEVfPv5P6j0EOZ-x</recordid><startdate>20111201</startdate><enddate>20111201</enddate><creator>Pokushalov, Evgeny</creator><creator>Romanov, Alexander</creator><creator>Corbucci, Giorgio</creator><creator>Prohorova, Darya</creator><creator>Chernyavsky, Alexander</creator><creator>Larionov, Petr</creator><creator>Terekhov, Igor</creator><creator>Artyomenko, Sergey</creator><creator>Kliver, Elena</creator><creator>Shirokova, Natalya</creator><creator>Karaskov, Alexander</creator><creator>Dib, Nabil</creator><general>Springer US</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111201</creationdate><title>Cardiac Resynchronization Therapy and Bone Marrow Cell Transplantation in Patients with Ischemic Heart Failure and Electromechanical Dyssynchrony: A Randomized Pilot Study</title><author>Pokushalov, Evgeny ; Romanov, Alexander ; Corbucci, Giorgio ; Prohorova, Darya ; Chernyavsky, Alexander ; Larionov, Petr ; Terekhov, Igor ; Artyomenko, Sergey ; Kliver, Elena ; Shirokova, Natalya ; Karaskov, Alexander ; Dib, Nabil</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c343t-f10b5e30ae7dd37183ba114e0a3cf495bd1c920e4c740d1ea0ab62583b1995053</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Biomedical Engineering and Bioengineering</topic><topic>Biomedicine</topic><topic>Bone Marrow Transplantation - adverse effects</topic><topic>Bundle-Branch Block - diagnosis</topic><topic>Bundle-Branch Block - etiology</topic><topic>Bundle-Branch Block - physiopathology</topic><topic>Bundle-Branch Block - therapy</topic><topic>Cardiac Resynchronization Therapy - adverse effects</topic><topic>Cardiology</topic><topic>Chi-Square Distribution</topic><topic>Combined Modality Therapy</topic><topic>Coronary Circulation</topic><topic>Cross-Over Studies</topic><topic>Echocardiography, Doppler</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - etiology</topic><topic>Heart Failure - physiopathology</topic><topic>Heart Failure - therapy</topic><topic>Human Genetics</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Myocardial Ischemia - complications</topic><topic>Myocardial Ischemia - diagnosis</topic><topic>Myocardial Ischemia - physiopathology</topic><topic>Myocardial Ischemia - therapy</topic><topic>Myocardial Perfusion Imaging - methods</topic><topic>Pilot Projects</topic><topic>Predictive Value of Tests</topic><topic>Quality of Life</topic><topic>Recovery of Function</topic><topic>Russia</topic><topic>Single-Blind Method</topic><topic>Stroke Volume</topic><topic>Surveys and Questionnaires</topic><topic>Time Factors</topic><topic>Tomography, Emission-Computed, Single-Photon</topic><topic>Treatment Outcome</topic><topic>Ventricular Dysfunction, Left - diagnosis</topic><topic>Ventricular Dysfunction, Left - etiology</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><topic>Ventricular Dysfunction, Left - therapy</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pokushalov, Evgeny</creatorcontrib><creatorcontrib>Romanov, Alexander</creatorcontrib><creatorcontrib>Corbucci, Giorgio</creatorcontrib><creatorcontrib>Prohorova, Darya</creatorcontrib><creatorcontrib>Chernyavsky, Alexander</creatorcontrib><creatorcontrib>Larionov, Petr</creatorcontrib><creatorcontrib>Terekhov, Igor</creatorcontrib><creatorcontrib>Artyomenko, Sergey</creatorcontrib><creatorcontrib>Kliver, Elena</creatorcontrib><creatorcontrib>Shirokova, Natalya</creatorcontrib><creatorcontrib>Karaskov, Alexander</creatorcontrib><creatorcontrib>Dib, Nabil</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular translational research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pokushalov, Evgeny</au><au>Romanov, Alexander</au><au>Corbucci, Giorgio</au><au>Prohorova, Darya</au><au>Chernyavsky, Alexander</au><au>Larionov, Petr</au><au>Terekhov, Igor</au><au>Artyomenko, Sergey</au><au>Kliver, Elena</au><au>Shirokova, Natalya</au><au>Karaskov, Alexander</au><au>Dib, Nabil</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiac Resynchronization Therapy and Bone Marrow Cell Transplantation in Patients with Ischemic Heart Failure and Electromechanical Dyssynchrony: A Randomized Pilot Study</atitle><jtitle>Journal of cardiovascular translational research</jtitle><stitle>J. of Cardiovasc. Trans. Res</stitle><addtitle>J Cardiovasc Transl Res</addtitle><date>2011-12-01</date><risdate>2011</risdate><volume>4</volume><issue>6</issue><spage>767</spage><epage>778</epage><pages>767-778</pages><issn>1937-5387</issn><eissn>1937-5395</eissn><abstract>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.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>21547598</pmid><doi>10.1007/s12265-011-9283-1</doi><tpages>12</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1937-5387 |
| ispartof | Journal of cardiovascular translational research, 2011-12, Vol.4 (6), p.767-778 |
| issn | 1937-5387 1937-5395 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Aged Biomedical Engineering and Bioengineering Biomedicine Bone Marrow Transplantation - adverse effects Bundle-Branch Block - diagnosis Bundle-Branch Block - etiology Bundle-Branch Block - physiopathology Bundle-Branch Block - therapy Cardiac Resynchronization Therapy - adverse effects Cardiology Chi-Square Distribution Combined Modality Therapy Coronary Circulation Cross-Over Studies Echocardiography, Doppler Exercise Test Female Heart Failure - diagnosis Heart Failure - etiology Heart Failure - physiopathology Heart Failure - therapy Human Genetics Humans Male Medicine Medicine & Public Health Middle Aged Myocardial Ischemia - complications Myocardial Ischemia - diagnosis Myocardial Ischemia - physiopathology Myocardial Ischemia - therapy Myocardial Perfusion Imaging - methods Pilot Projects Predictive Value of Tests Quality of Life Recovery of Function Russia Single-Blind Method Stroke Volume Surveys and Questionnaires Time Factors Tomography, Emission-Computed, Single-Photon Treatment Outcome Ventricular Dysfunction, Left - diagnosis Ventricular Dysfunction, Left - etiology Ventricular Dysfunction, Left - physiopathology Ventricular Dysfunction, Left - therapy Ventricular Function, Left |
| title | Cardiac Resynchronization Therapy and Bone Marrow Cell Transplantation in Patients with Ischemic Heart Failure and Electromechanical Dyssynchrony: A Randomized Pilot Study |
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