Functional Recovery after Intramyocardial Injection of Adipose-Derived Stromal Cells Assessed by Cardiac Magnetic Resonance Imaging

Abstract

Aims. A major clinical concern is the continuous increase in the number of patients diagnosed with advanced coronary artery disease, ischemic heart failure, and refractory angina, and one of the most promising treatment options for these conditions is stem cell-based therapy. The aim of this study was to assess the functional improvement following intramyocardial injection of adipose-derived stromal cells, using cardiac magnetic resonance. Methods and Results. Thirteen patients with ischemic heart failure, reduced left ventricular ejection fraction, refractory angina, and who have been disqualified from any form of direct revascularization were enrolled in the study with transthoracic autologous adipose-derived stromal cell implantation. All patients underwent cardiac magnetic resonance prior to the procedure and after 12 months of follow-up. A significant increase in stroke volume ( $83.1\pm 8.5\text{mL}$ vs $93.8\pm 13.8\text{mL}$ , $p=0.025$ ) and stroke volume index ( $43.3\pm 7.6\text{mL}/{\text{m}}^2$ vs $48.7\pm 9.1\text{mL}/{\text{m}}^2$ , $p=0.019$ ), a statistical trend toward an increase in left ventricle ejection fraction ( $36.7\pm 13.2$ vs $39.7\pm 14.9$ , $p=0.052$ ), and cardiac output improvement ( $5.0\pm 0.7$ vs $5.5\pm 0.9$ , $p=0.073$ ) was observed in the patient postprocedure. Enhanced relative regional thickening was noted in the segments with adipose-derived stromal cell implantation. Conclusions. Intramyocardial adipose-derived stromal cell implantation is a promising therapeutic option for selected, symptomatic patients with ischemic heart failure, who have preserved myocardial viability despite being unsuitable for direct revascularization.