Cellular cardiomyoplasty in refractory angina: experimental substantiation of the optimal method and clinical experience

Abstract

Objective. Experimental substantiation of the optimal method of cellular cardiomyoplasty and familiarization with clinical experience. Materials and methods. The study included experimental and clinical parts. The experimental part was performed on 122 rats of the Wistar–Cayote inbred line weighing 200 – 220 g, which were induced with myocardial infarction by stitching and ligation of the anterior interventricular artery. The animals were divided into five groups, and each group (except for the control) was treated with different routes of stem cell injection. Markers of neoangiogenesis in the blood serum, concentration of vascular endothelial growth factor, endothelin–1 level were studied in the dynamics, echocardiography was performed to calculate cardiac function. The clinical part of the study was based on the analysis of the results of treatment of 30 patients who were studied for the effectiveness of the use of autologous mesenchymal stem cells on myocardial remodeling. The diagnosis was made based on the clinical picture, anamnesis, and the results of invasive and non–invasive examination methods. Results. Experimental studies have shown a positive effect of intramyocardial injection of autologous mesenchymal stem cells on the functional reserve and metabolism of cardiomyocytes due to the paracrine effect and stimulation of angiogenesis. This was confirmed by a statistically significant increase in the level of vascular endothelial growth factor, an increase in the concentration of nitric oxide derivatives with a simultaneous decrease in the concentration of endothelin–1 to normal values. Transplantation of autologous bone marrow stem cells increased left ventricular ejection fraction (t = 2.5, p < 0.05) and stroke volume (t = 1.9, p < 0.05). Conclusions. Optimal transmyocardial injection of stem cells. The clinical study showed an improvement in total unipolar voltage from (7.3± 1.1) to (8.9± 1.8) mV after 6 months and (8.1± 1.3) mV after 12 months (p= 0.03), positive changes in intracardiac hemodynamics and reduction in the depth and area of myocardial perfusion defects, promotion of neoangiogenesis, and improvement of patients' quality of life.