Trans-endocardial delivery of progenitor cells to compromised myocardium using the "needle technique"and risk of myocardial injury

Leszek Drabik; Adam Mazurek; Monika Dzieciuch-Rojek; Lukasz Tekieli; Łukasz Czyż; Ewa Kwiecień; Aleksandra Kułaga; Aleksandra Mikunda; Jakub Chmiel; Wojciech Płazak; Paweł Rubiś; Piotr Musiałek

doi:10.5114/aic.2022.121033

Trans-endocardial delivery of progenitor cells to compromised myocardium using the "needle technique"and risk of myocardial injury

Postepy Kardiol Interwencyjnej. 2022 Dec;18(4):423-430. doi: 10.5114/aic.2022.121033. Epub 2022 Nov 14.

Authors

Leszek Drabik^{1

2}, Adam Mazurek¹, Monika Dzieciuch-Rojek³, Lukasz Tekieli¹, Łukasz Czyż¹, Ewa Kwiecień⁴, Aleksandra Kułaga¹, Aleksandra Mikunda¹, Jakub Chmiel¹, Wojciech Płazak^{1

5}, Paweł Rubiś^{1

5}, Piotr Musiałek^{1

5}

Affiliations

¹ Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland.
² Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland.
³ 1 Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
⁴ Department of Cardiology and Internal Medicine, Ludwik Rydygier Memorial Specialized Hospital, Krakow, Poland.
⁵ Jagiellonian University Medical College, Krakow, Poland.

Abstract

Introduction: Recent analysis from CHART-1 study indicated that the therapeutic effects of trans-endocardial cardiopoetic cell transplantation in chronic ischemic heart failure (iCHF) may be lost with an increasing number of injections perfomed to deliver therapeutic cells.

Aim: To evaluate global and regional contractility and diastolic function of the left ventricle of patients with iCHF who received trans-endomyocardial cardiopoietic stem cells (CSCs) delivery or sham procedures.

Material and methods: The study included patients (mean age: 60.8 ±7.1 years) with iCHF (left ventricular ejection fraction (LVEF) < 35%) and a history of hospitalization for worsening heart failure within 12 months despite optimal medical therapy. The patients underwent transmyocardial CSCs transplantation using perforated needle technique or a sham procedure. The wall motion score index (WMSI), LVEF, transmitral E-velocity, E-wave deceleration time, E/A-ratio, and E/e'-mean value were measured with two-dimensional echocardiography on days 1 and 30.

Results: A total of 170 segments were analyzed, including 48 targeted segments where 92 injections of 0.5 ml of CSCs were performed. In the transendocardial injections cohort, a decrease in regional contractility was observed in 30.6% (26/85) and 18.9% (16/85) of the segments on days 1 and 30, respectively. This was accompanied by an increase in WMSI by 0.32 ±0.06 and 0.19 ±0.18 (day 1, p = 0.02, day 30, p = 0.03) and a reduction in LVEF (-3.15 ±1.23%, p = 0.065).

Conclusions: Transendocardial injections performed to deliver therapeutic cells were associated with myocardial injury. This adverse effect remained, albeit at a lesser degree, at 30-days. Mechanical injury with trans-endocardial delivery of progenitor cells using the "needle technique" may counterbalance, at least in part, any cell-related benefit(s).

Keywords: heart failure cell therapy; stem cells; transmyocardial cell transplantation; treatment outcome; ventricular function; wall motion score index.