| 박상돈, 신성희¹ , 우성일¹ , 권준¹ , 박금수¹ , 이준원² , 이승환 ² , 윤정환² , 최동훈³ , 장양수³ , 김대혁¹ |
Background: Although stem cells, including mesenchymal stem cells (MSCs), have been demonstrated to improve cardiac function following acute ST-segment elevation myocardial infarction (STEMI), there was no enough data for the effect of MSC on heart rate variability (HRV) that have shown predictive value for the cardiac events in patients with STEMI. In this randomized controlled trial, the effects of intracoronary transfer of autologous MSC on HRV were assessed in post STEMI patients.
Methods: Fifty six patients with STEMI who underwent primary PCI or thrombolytic therapy, were randomly assigned to either the MSC group (optimized treatment with intracoronary transfer of autologous MSC, n=30) or the control group (optimized treatment only, n=26). After bone marrow cells were obtained from the MSC group, MSCs were isolated and culture expanded for 4 weeks. After 30 day from STEMI, an average of 1X106 MSCs/kg was injected directly into infarct related coronary artery by the use of a balloon catheter. HRV was assessed on 24-hour holter-ECG at pre-discharge, 1-month and 6-month later. In addition, transthoracic echocardiography (TTE) and SPECT were performed at pre-discharge and 6month later.
Results: At a follow-up of 6months, there were no arrhythmia and other side effects, including infections, allergic reactions or adverse clinical events. After 6 months, changes of ejection fraction measured by SPECT (5.9±8.5 vs. 1.6±6.9%, p=0.037) and TTE (1.9±2.7 vs.-0.5±1.8%, p<0.001) were significantly higher in the MSC group than the control group. Among HRA indexes, standard deviation of all beat to beat intervals (SDNN: 9.3±20 vs. -9.2±22ms, p=0.002) and the standard deviation of the averages of RR intervals in 5-miniute segments (SDANN: 7.8±20 vs. -14±25ms, p=0.001) were significantly increased in the MSC group while decreased in control group. Other HRV indexes also represented increase of values in the MSC group but it didn’t show the difference between two groups.
Conclusions: This study demonstrates that treatment with autologous MSC was safe and feasible in patients with STEMI. In this trial, transplantation of intracoronary autologous MSC showed significant improvement of depressed HRV, especially in time domain variables, in post STEMI patient after optimized treatment.
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