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Intracoronary Autologous Bone Marrow–Derived Mononuclear Cell Transplantation Improves Coronary Collateral Vessel Formation and Recruitment Capacity in Patients With Ischemic Cardiomyopathy: A Combined Hemodynamic and Scintigraphic Approach

Department of Cardiology, University of Istanbul, yeldatayyareci{at}hotmail.com

Murat Sezer, MD

Department of Cardiology, University of Istanbul

Berrin Umman, MD

Department of Cardiology, University of Istanbul

Sevgi Besisik, MD

Department of Hematology, University of Istanbul

Ayse Mudun, MD

Department of Nuclear Medicine Istanbul Faculty of Medicine, University of Istanbul, Turkey

Yasemin Sanli, MD

Department of Nuclear Medicine Istanbul Faculty of Medicine, University of Istanbul, Turkey

Aytac Oncul, MD

Department of Cardiology, University of Istanbul

Nuray Gurses, PhD

Department of Hematology, University of Istanbul

Deniz Sargin, MD

Department of Hematology, University of Istanbul

Mehmet Meric, MD

Department of Cardiology, University of Istanbul

Yilmaz Nisanci, MD

Department of Cardiology, University of Istanbul

This study investigated the effects of intracoronary autologous bone marrow–derived mononuclear cell (BMC) transplantation on coronary microcirculation. Fifteen patients with ischemic cardiomyopathy were treated by intracoronary infusion of BMCs via the patent infarct-related artery. The thermodilution-derived coronary flow reserve, index of microvascular resistance, pressure-derived collateral flow index, and coronary wedge pressure were measured at baseline and at 6 months. Successive balloon inflations during BMC transplantation were performed to observe the recruitment in pressure-derived collateral flow index and coronary wedge pressure, and the percentage changes between baseline and 6 months were calculated. The mean (SD) coronary flow reserve increased from 1.3 (0.4) to 2.1 (0.5), and the mean (SD) index of microvascular resistance decreased from 44.9 (24.4) to 21.2 (14.1) (P = .001 for both). The mean (SD) improvement in pressure-derived collateral flow index (from 0.14 [0.05] to 0.22 [0.08]) was also statistically significant (P = .001). Similarly, the percentage improvements in pressure-derived collateral flow index and coronary wedge pressure were statistically significant (P = .01 for both). The percentage improvement in perfusion assessed by single-photon emission computed tomography strongly correlated with the percentage changes in pressure-derived collateral flow index (r = 0.88, P = .001) and coronary wedge pressure (r = 0.69, P = .01). These results demonstrate for the first time (to our knowledge) that intracoronary autologous BMC transplantation improves coronary collateral vessel formation and recruitment capacity in human subjects.

Key Words: autologous bone marrow–derived mononuclear cells • coronary collateral vessels • collateral recruitment • neovascularization • ischemic cardiomyopathy

Angiology, Vol. 59, No. 2, 145-155 (2008)
DOI: 10.1177/0003319707305688


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