Effects of Transendocardial Delivery of Bone Marrow-Derived CD133+ Cells on Left Ventricle Perfusion and Function in Patients With Refractory Angina: Final Results of Randomized, Double-Blinded, Placebo-Controlled REGENT-VSEL Trial.
Circ Res
; 120(4): 670-680, 2017 Feb 17.
Article
in En
| MEDLINE
| ID: mdl-27903568
ABSTRACT
RATIONALE New therapies for refractory angina are needed. OBJECTIVE:
Assessment of transendocardial delivery of bone marrow CD133+ cells in patients with refractory angina. METHODS ANDRESULTS:
Randomized, double-blinded, placebo-controlled trial enrolled 31 patients with recurrent Canadian Cardiovascular Society II-IV angina, despite optimal medical therapy, ≥1 myocardial segment with inducible ischemia in Tc-99m SPECT who underwent bone marrow biopsy and were allocated to cells (n=16) or placebo (n=15). Primary end point was absolute change in myocardial ischemia by SPECT. Secondary end points were left ventricular function and volumes by magnetic resonance imaging and angina severity. After 4 months, there were no significant differences in extent of inducible ischemia between groups (summed difference score mean [±SD] 2.60 [2.6] versus 3.63 [3.6], P=0.52; total perfusion deficit 3.60 [3.6] versus 5.01 [4.3], P=0.32; absolute changes of summed difference score -1.38 [5.2] versus -0.73 [1.9], P=0.65; and total perfusion deficit -1.33 [3.3] versus -2.19 [6.6], P=0.65). There was a significant reduction of left ventricular volumes (end-systolic volume -4.3 [11.3] versus 7.4 [11.8], P=0.02; end-diastolic volume -9.1 [14.9] versus 7.4 [15.8], P=0.02) and no significant change of left ventricular ejection fraction in the cell group. There was no difference in number of patients showing improvement of ≥1 Canadian Cardiovascular Society class after 1 (41.7% versus 58.3%; P=0.68), 4 (50% versus 33.3%; P=0.63), 6 (70% versus 50.0%; P=0.42), and 12 months (55.6% versus 81.8%; P=0.33) and use of nitrates after 12 months.CONCLUSION:
Transendocardial CD133+ cell therapy was safe. Study was underpowered to conclusively validate the efficacy, but it did not show a significant reduction of myocardial ischemia and angina versus placebo. CLINICAL TRIAL REGISTRATION URL http//www.clinicaltrials.gov. Unique identifier NCT01660581.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Ventricular Function, Left
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Bone Marrow Transplantation
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Endocardium
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AC133 Antigen
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Angina Pectoris
Type of study:
Clinical_trials
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limits:
Aged
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Female
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Humans
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Male
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Middle aged
Country/Region as subject:
America do norte
Language:
En
Journal:
Circ Res
Year:
2017
Type:
Article