© 2006 American Heart Association, Inc.
Letter to the Editor |
CPCs as Treatment for Chronic Total Coronary Artery Occlusions
University of Minnesota, Minneapolis Heart Institute, Abbott Northwestern Hospital
To the Editor:
The recent observation by Erbs et al1 that an intracoronary infusion of blood-derived progenitor cells (CPCs) improves LV function after recanalization of a chronic coronary total occlusion (CTO) may represent a new application of cellular therapy for ischemic heart disease. Twenty-six patients underwent PET and SPECT imaging to determine myocardial hibernation 8 days after successful recanalization of their CTO and then received CPCs (69 million; n=13) or placebo (cell medium; n=13) 2 days later through a PTCA balloon during 4 cycles of 2-minute occlusion and reperfusion. Left ventricular ejection fraction was obtained by cardiac MRI 8 days after recanalization and 3 months later. They noted that the LVEF improved in the CPC group from 52% to 59% with no change in the placebo group. Wall motion score improved from 71 to 77 in the CPC group yet worsened in the Control group (P<0.05). The number of hibernating myocardial segments decreased from 2.9+0.6 to 2.0+0.6 at 3 months in the CPC group but increased from 2.6+0.6 to 3.6+0.6 in the Control group at 3 months (P=NS).
However, the stated benefit of this therapy totally relies on the relative improvement in the CPC group at 3 months compared with a Control group where the LV function did not change and the number of viable segments actually worsened. This lack of improvement in the control group contrasts with many previously published studies2–6 demonstrating an improvement in LV function in the majority of patients after PTCA of a CTO when the artery remains patent at follow-up. In fact, several of the studies report improvement in LV function that is equal to or greater than that observed in the CPC group. Patients with CTO constitute a very heterogeneous group with regard to collateral circulation and degree of infarction distal to the CTO which could affect the outcome of recanalization attributable to the small sample sizes reported in this study. It is disappointing that the authors did not discuss the lack of improvement in the Control group that made the response in the CPC group appear so robust.
References
1. Erbs S, Linke A, Adams V, Lenk K, Thiele H, Diederich KW, Emmrich F, Kluge R, Kendziorra K, Sabri O, Schuler G, Hambrecht R. Transplantation of blood-derived progenitor cells after recanalization of chronic coronary artery occlusion. Circ Res. 2005; 97: 756–762.
2. Gottschall CA, Trindade II, Miler VV. Changes in left ventricular function after coronary recanalization by percutaneous transluminal coronary angioplasty (PTCA). J Invasive Cardiol. 1997; 9: 146–153.[Medline] [Order article via Infotrieve]
3. Sirnes PA, Myreng Y, Molstad P, Bonarjee V, Golf S. Improvement in left ventricular ejection fraction and wall motion after successful recanalization of chronic coronary occlusions. Eur Heart J. 1998; 19: 273–281.
4. Engelstein E, Terres W, Hofmann D, Hansen L, Hamm CW. Improved global and regional left ventricular function after angioplasty for chronic coronary occlusion. Clin Investig. 1994; 72: 442–447.[Medline] [Order article via Infotrieve]
5. Danchin N, Angioi M, Cador R, Tricoche O, Dibon O, Juilliere Y, Cuilliere M, Cherrier F. Effect of late percutaneous angioplastic recanalization of total coronary artery occlusion on left ventricular remodeling, ejection fraction, and regional wall motion. Am J Cardiol. 1996; 78: 729–735.[CrossRef][Medline] [Order article via Infotrieve]
6. Werner GS, Emig U, Bahrmann P, Ferrari M, Figulla HR. Recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion. Heart. 2004; 90: 1303–1309.
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  S. Erbs, A. Linke, G. Schuler, and R. Hambrecht Intracoronary Administration of Circulating Blood-Derived Progenitor Cells After Recanalization of Chronic Coronary Artery Occlusion Improves Endothelial Function Circ. Res., March 17, 2006; 98(5): e48 - e48. [Full Text] [PDF]
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