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      Pilot study to evaluate the safety and feasibility of intracoronary CD133(+) and CD133(-) CD34(+) cell therapy in patients with nonviable anterior myocardial infarction.

      Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

      Adult, Aged, Antigens, CD, analysis, Antigens, CD34, Bone Marrow Transplantation, adverse effects, methods, Coronary Circulation, Echocardiography, Feasibility Studies, Female, Follow-Up Studies, Glycoproteins, Humans, Immunophenotyping, Male, Middle Aged, Myocardial Infarction, pathology, physiopathology, surgery, Peptides, Pilot Projects, Prospective Studies, Research Design, Stem Cell Transplantation, Stem Cells, immunology, Time Factors, Tomography, Emission-Computed, Single-Photon, Treatment Outcome, Ventricular Function, Left, Ventricular Remodeling

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          Abstract

          The long-term effect of intracoronary infusion of progenitor cells in patients with chronic ischemic cardiomyopathy. Bone marrow stem-cell administration in patients with myocardial infarction improved myocardial performance and in some studies contributed to favorable left ventricular remodeling. We report on the results of a pilot, single center, controlled safety, and feasibility study, including 24 patients with old, nonviable anterior myocardial infarction. Twelve patients underwent intracoronary administration of selected CD133(+) and CD133(-)CD34(+) progenitor cells and 12 were followed up on medical therapy. Left ventricular volumes and ejection fraction, at rest and during low-dose dobutamine, and myocardial viability, using TL-201 reinjection scintigraphy, were analyzed at baseline and long-term follow-up. Patients in the treatment group experienced a sustained decrease in left ventricular end-diastolic and end-systolic resting volumes (P = 0.008 and P = 0.002, respectively), as well as an improvement in global ejection fraction at rest [from (27.2 +/- 6.8)% to (29.7 +/- 7.3)%, P = 0.016]. Segmental anterior and apical wall perfusion, during TL-201 reinjection, were similarly improved (P = 0.005 and P < 0.001, respectively). One patient developed restenosis at the cell delivery site and one progression of atherosclerosis. During 28.0 +/- 8.7 months of clinical follow-up, only one patient experienced deterioration of heart failure. In the control group, we observed stability in the perfusion defect and deterioration in end-diastolic and end-systolic volumes (P= 0.002 and P = 0.003, respectively) and a nonsignificant decrease in ejection fraction (P = 0.11). Intracoronary infusion of selected CD133(+) and CD133(-)CD34(+) progenitor cells to a previously infarcted and nonviable anterior wall is safe, and results in sustained improvement in segmental myocardial perfusion and in favorable left ventricular remodeling. (c) 2007 Wiley-Liss, Inc.

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          17394248
          10.1002/ccd.21023

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