Kozlov I. Intramyocardial transplantation of peripheral blood progenitor cells in combined treatment of patients with ischemic cardiomyopathy

Autologous peripheral blood progenitor cell transplantation in patients with ischemic cardiomyopathy who exhausted potentialities of standard treatment options seems to have been perspective. The main purpose of this study was to improve treatment efficiency of patients with ischemic cardiomyopathy through an ameliorated approach of autologous intramyocardial peripheral blood progenitor cell transplantation and mathematical methods of its results prognosis. Patients with ischemic cardiomyopathy were divided into two treatment arms: autologous peripheral blood progenitor cell transplantation in combination with optimal drug therapy (group 1, n=29) versus optimal drug therapy alone (group 2, n=31). Patients of the group 1 received granulocyte colony-stimulating factor at a dose 5 мg/kg for 5 days. Leukapheresis was performed on the fifth day. Isolation of mononuclear cells was done by Ficoll-Paque 1.077 g/ml density gradient centrifugation. Intramyocardial transplantation was performed by NOGA XP Cardiac Navigation System and Myostar catheter. Follow up occurred at 1, 3, 6, 12 and 18 months. The probability of event-free cell transplants obtaining that contain progenitor cells in patients with ischemic cardiomyopathy was 0,76 (95 % CI 0,72 - 0,78). It was noticed that during follow up the maximum effect of intramyocardial transplantation occurred after 6 months after the intervention. Comparably to the baseline values, left ventricular ejection fraction increased by an average by (31,7±0,1) %, end diastolic volume decreased by (15,7±0,1) %, 6-minutes walking test tolerance increased by (77,9±0,1) %. It has been estimated that the most valuable indications for intramyocardial peripheral blood progenitor cell transplantation for patients with ischemic cardiomyopathy are local and global left ventricle contractility disturbances associated with left ventricle ejection fraction <35 % and existence of hibernated myocardium areas evaluated by stress-echocardiography. Prognosis for left ventricle ejection fraction increasing after progenitor cell transplantation is based on linear equation: y=1,44+0,71?x, where "y" is increasing of left ventricle ejection fraction during 6 months, "x" are grades given via stress-echocardiography test. An ameliorated approach of autologous intramyocardial peripheral blood progenitor cell transplantation with mathematical methods of its results prognosis is effective treatment option for patients with ischemic cardiomyopathy who exhausted standard treatment options.