Key result
Intracoronary bone marrow cell transfer temporarily improves diastolic function, but benefits fade by 5 years.
Why the study?
No clinical study has addressed the long-term effect of intracoronary autologous bone marrow cell transfer on diastolic function after acute myocardial infarction.
Does intracoronary autologous bone marrow cell transfer improve long-term diastolic function in patients after acute ST-elevation MI?
RCT (n=56)
Blinded
Randomized
Does intracoronary autologous bone marrow cell transfer improve long-term diastolic function in patients after acute ST-elevation MI?
Intracoronary autologous bone marrow cell transfer provides an early improvement in diastolic function after AMI, but this effect is not sustained at 5 years.
Transient E/A improvement after bone marrow cell transfer fades by 5 years; leaves open durable cell-therapy strategies for diastolic function.
AIMS: We have recently observed that intracoronary autologous bone marrow cell (BMC)-transfer improves parameters of diastolic function in patients after acute myocardial infarction at 6 and 18 months. There is no clinical study addressing the long-term effect of BMC transfer on diastolic function. Therefore, we conducted a 5-year follow-up of the BOOST trial to evaluate a sustained benefit on echocardiographic parameters on diastolic function. METHODS AND RESULTS: After successful primary percutaneous coronary intervention (PCI) for acute ST-elevation MI, patients were randomized to a control (n = 28) or BMC transfer group (n = 28). Echocardiography was performed at 4.5 +/- 1.5 days after PCI, at 6, 18, and 60 months. Diastolic function was determined by measuring transmitral flow velocities (E/A ratio), diastolic myocardial velocities (E(a)/A(a) ratio), isovolumic relaxation time (IVRT), and deceleration time (DT). All analyses were performed in a blinded fashion. There was an overall treatment effect of BMC transfer on E/A (0.25 +/- 0.10; 95% CI 0.05-0.44; P = 0.01). E/A ratio was significantly lower at 6 (Control 0.90 +/- 0.07; BMC 1.23 +/- 0.14; P = 0.03) and 18 months (Control 0.87+/-0.04; BMC 1.13 +/- 0.09; P = 0.01) in the control group, whereas E/A ratio was not different at 60 months between both groups (Control 0.90 +/- 0.06; BMC 1.05 +/- 0.07; P = 0.12). We found no overall effect of BMC transfer on E(a)/A(a) ratio (0.21 +/- 0.14; 95% CI -0.03 to 0.46; P = 0.09), DT (-12 +/- 11 ms; 95% CI -21 to 28; P = 0.75), IVRT -6 +/- 7 ms; 95% CI -9 to 19; P = 0.43), and E/E(a) ratio (0.58 +/- 0.88; 95% CI -1.18 to 2.34; P = 0.51). CONCLUSION: Intracoronary autologous BMC transfer provides an overall treatment effect on echocardiographic parameters of diastolic function in patients after AMI. However, this effect is basically related to an early improvement of parameters of diastolic function without a sustained effect on long-term follow-up.
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Schaefer et al. (2009) conducted an RCT in Acute myocardial infarction (n=56). Intracoronary autologous bone marrow cell (BMC) transfer vs. Control was evaluated on Overall treatment effect on E/A ratio (transmitral flow velocities) (MD 0.25, 95% CI 0.05-0.44, p=0.01). Intracoronary autologous bone marrow cell transfer improved the overall E/A ratio (MD 0.25; 95% CI 0.05-0.44; P=0.01), but this diastolic function benefit was not sustained at 5 years (P=0.12).
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