Introducción

Background: Pilot studies suggest that intracoronary transplantation of unselected ABMMC cells may improve Left Ventricular Ejection Fraction (LVEF) in heart failure (HF) patients. Methods: Eighteen patients were enrolled and completed 1 year follow up. Patients underwent SPECT evaluation, all had ejection fraction < 35%, 6 patients were randomly allocated to the control group and 12 in Bone Marrow Cells (BMC) group, median age 65 years old, male/female ratio 17/1; all with ischemic cardiomyopathy. All of cohort had NYHA class of III with maximal medical therapy and median basal LEVF was 29,8%. Median number of mononuclear and CD34+ cells infused were 8.1^∗10⁸ and 1.2^∗10⁷ respectively in a 50 cc delivered retrograde via coronary sinus approach using balloon occlusion “over wire” for 8 to 10 minutes. No study related adverse events were observed. Results: After a median time of 21 days, patients in the BMC group had relief of dyspnea symptoms and improvement in functional class. At 1 year, NYHA class improved in 92% of the patients in the BMC group by at least 1 class and no improvement in the control group. Mean improvements of LVEF post BMC transplantation were 5.0% and 7.4% at rest and stress SPECT respectively. Either rest and stress LVEF differences at one-year follow up and baseline between the BMC and control groups demonstrated significant difference; with rest LVEF was 4.8% vs 1.1% (p = 0.016) and with stress LVEF was 7.4% vs 0.08% (p = 0.001). Conclusions: Infusion of progenitor cells into the coronary sinus is safe and feasible in the ischemic HF patients. It is associated with significant improvement in symptoms, functional capacity and LVEF. Larger randomized studies are in progress.