Improvement of exercise-induced cardiac deformation after cell therapy for severe chronic ischemic heart failure

Background: Intracoronary infusion of autologous bone marrow cells (CTX) has been shown to improve myocardial function in postinfarct patients and in patients with chronic ischemic cardiomyopathy. Whether CTX affects exercise-induced changes in cardiac deformation and mitral regurgitation (MR) in patients with end-stage heart failure has not been studied. Methods and Results: In this small pilot study, 11 patients with chronic ischemic cardiomyopathy, ejection fraction (EF) < 25%, no inducible ischemia and heart failure class New York Heart Association (NYHA) III underwent CTX. Symptom-limited bicycle exercise echocardiography was performed pre- and 4 months post-CTX and maximum systolic strain (msy epsilon), peak systolic strain rate (psysr), and effective regurgitant orifice of MR (ERO) were determined. There were no complications related to the procedure. The overall clinical benefit of CTX was limited with a trend towards improvement (NYHA 3.0 +/- 0.1 pre- and 2.7 +/- 0.2 post-CTX, P = .06). The EF did not improve after CTX. The wall motion score index did not change at rest but decreased significantly during exercise (1.48 +/- 0.16 versus 1.44 +/- 0.17, P = .01). In patients with non-viable areas, msye, psysr, and ERO were not affected by CTX. However, in patients with viable areas, msy epsilon and psysr appeared to increase during exercise and ERO appeared to decrease from 19 +/- 5 to 16 +/- 5 mm(2). This effect was not apparent at rest and more pronounced with inferior viability. Conclusion: CTX may improve cardiac deformation and MR during exercise in patients with severe chronic heart failure when viable areas are targeted.