Additional improvement in regional myocardial ischemia after intracardiac injection of bone marrow cells during CABG surgery

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorGOWDAK, Luis Henrique Wolff
dc.contributor.authorSCHETTERT, Isolmar Tadeu
dc.contributor.authorROCHITTE, Carlos Eduardo
dc.contributor.authorCARVALHO, Leonardo P. de
dc.contributor.authorVIEIRA, Marcelo Luiz Campos
dc.contributor.authorDALLAN, Luis Alberto Oliveira
dc.contributor.authorOLIVEIRA, Sergio Almeida de
dc.contributor.authorCESAR, Luiz Antonio Machado
dc.contributor.authorBRITO, Jose Oscar Reis
dc.contributor.authorGUARITA-SOUZA, Luiz Cesar
dc.contributor.authorCARVALHO, Antonio Carlos Campos de
dc.contributor.authorKRIEGER, Jose Eduardo
dc.contributor.groupauthorMiHeart IHD Investigators
dc.date.accessioned2023-04-14T17:50:35Z
dc.date.available2023-04-14T17:50:35Z
dc.date.issued2023
dc.description.abstractBackground: Post-procedure residual ischemia is associated with worse prognosis in patients with coronary artery diasease (CAD).Objective: We evaluated whether autologous bone marrow-derived cells (BMC) contribute to additional reduction in regional stress-induced myocardial ischemia (SIMI) in patients undergoing incomplete coronary artery bypass graft surgery (CABG).Methods: In a double-blind, randomized, placebo-controlled trial, we enrolled 143 patients (82% men, 58 & PLUSMN; 11 years) with stable CAD and not candidates for complete CABG. They received 100 million BMC (n = 77) or placebo (n = 66) injected into ischemic non-revascularized segments during CABG. The primary outcome was improvement on SIMI quantified as the area at risk in injected segments assessed by cardiovascular magnetic resonance (CMR) 1, 6, and 12 months after CABG.Results: The reduction in global SIMI after CABG was comparable (p = 0.491) in both groups indicating sustained beneficial effects of the surgical procedure over 12 month period. In contrast, we observed additional improvement in regional SIMI in BMC treated group (p = 0.047). Baseline regional SIMI values were comparable [18.5 (16.2-21.0) vs. 18.5 (16.5-20.7)] and reached the lowest values at 1 month [9.74 (8.25; 11.49) vs. 12.69 (10.84; 14.85)] for BMC and placebo groups, respectively. The ischemia's improvement from baseline represented a 50% difference in regional SIMI in favor of the BMC transplanted group at 30 days. We found no differences in clinical and LVEF% between groups during the 12 month follow-up period. The 1 month rate of major adverse cerebral and cardiovascular events (MACCE) (p = 0.34) and all-cause mortality (p = 0.08) did not differ between groups 1 month post intervention.Conclusion: We provided evidence that BMC leads to additional reduction in regional SIMI in chronic ischemic patients when injected in segments not subjected to direct surgical revascularization. This adjuvant therapy deserves further assessment in patients with advanced CAD especially in those with microcirculation dysfunction.eng
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.description.sponsorshipMinistry of Health of Brazil (FINEP) [0-1-04-0967-0-0]
dc.identifier.citationFRONTIERS IN CARDIOVASCULAR MEDICINE, v.10, article ID 1040188, 8p, 2023
dc.identifier.doi10.3389/fcvm.2023.1040188
dc.identifier.issn2297-055X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/52894
dc.language.isoeng
dc.publisherFRONTIERS MEDIA SAeng
dc.relation.ispartofFrontiers in Cardiovascular Medicine
dc.rightsopenAccesseng
dc.rights.holderCopyright FRONTIERS MEDIA SAeng
dc.subjectmyocardial ischemiaeng
dc.subjectcoronary artery diseaseeng
dc.subjectbone marrow cellseng
dc.subjectcoronary artery bypass graft surgery (CABG)eng
dc.subjectcardiovascular magnetic resonanceeng
dc.subjectstress induced myocardial ischemiaeng
dc.subject.otherpercutaneous coronary interventioneng
dc.subject.otherprogenitor cellseng
dc.subject.otherartery-diseaseeng
dc.subject.otherheart-failureeng
dc.subject.otherflow reserveeng
dc.subject.otherrevascularizationeng
dc.subject.othermetaanalysiseng
dc.subject.otheroutcomeseng
dc.subject.otherinfarctioneng
dc.subject.othersurvivaleng
dc.subject.wosCardiac & Cardiovascular Systemseng
dc.titleAdditional improvement in regional myocardial ischemia after intracardiac injection of bone marrow cells during CABG surgeryeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.author.externalSCHETTERT, Isolmar Tadeu:Univ Sao Paulo Med Sch, Heart Inst InCor HCFMUSP, Lab Genet & Mol Cardiol, Sao Paulo, Brazil
hcfmusp.author.externalBRITO, Jose Oscar Reis:Natl Inst Cardiol, Dept Cardiovasc Surg, Rio De Janeiro, Brazil
hcfmusp.author.externalGUARITA-SOUZA, Luiz Cesar:Pontificia Univ Catolica Parana, Dept Cardiovasc Surg, Curitiba, Brazil
hcfmusp.author.externalCARVALHO, Antonio Carlos Campos de:Natl Inst Cardiol, Cell Technol Ctr, Rio De Janeiro, Brazil; Univ Fed Rio de Janeiro, Carlos Chagas Filho Biophys Inst, Rio De Janeiro, Brazil
hcfmusp.citation.scopus2
hcfmusp.contributor.author-fmusphcLUIS HENRIQUE WOLFF GOWDAK
hcfmusp.contributor.author-fmusphcCARLOS EDUARDO ROCHITTE
hcfmusp.contributor.author-fmusphcLEONARDO PINTO DE CARVALHO
hcfmusp.contributor.author-fmusphcMARCELO LUIZ CAMPOS VIEIRA
hcfmusp.contributor.author-fmusphcLUIS ALBERTO OLIVEIRA DALLAN
hcfmusp.contributor.author-fmusphcSERGIO ALMEIDA DE OLIVEIRA
hcfmusp.contributor.author-fmusphcLUIZ ANTONIO MACHADO CESAR
hcfmusp.contributor.author-fmusphcJOSE EDUARDO KRIEGER
hcfmusp.description.articlenumber1040188
hcfmusp.description.volume10
hcfmusp.origemWOS
hcfmusp.origem.pubmed36824456
hcfmusp.origem.scopus2-s2.0-85148588330
hcfmusp.origem.wosWOS:000936233100001
hcfmusp.publisher.cityLAUSANNEeng
hcfmusp.publisher.countrySWITZERLANDeng
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