Resultados iniciais do transplante de células de medula óssea para o miocárdio de pacientes com insuficiência cardíaca de etiologia chagásica

Abstract

OBJECTIVETo evaluate early effects of bone marrow cell transplantation to the myocardium of patients with heart failure (CHF) due to Chagas disease. METHODSWe studied 28 patients (mean age 52.2 ± 9.9), of whom 24 were male. Despite optimized treatment, 25 patients were in NYHA class III and three patients, in NYHA class IV. The procedure consisted of aspiration of 50 mL of bone marrow, separation of the mononuclear fraction, and intracoronary injection. Effects on left ventricle ejection fraction (LVEF), distance walked in the six-minute walking test, quality-of-life, NYHA class, arrhythmogenic and biochemical parameters, were all evaluated. RESULTSThere were no complications directly related to the procedure. Baseline left ventricular ejection fraction was 20.1 ± 6.8%, and 60 days after transplantation it increased to 23.0 ± 9.0%, p = 0.02. Signifi cant improvements were observed in the NYHA class (3.1 ± 0.3 to 1.8 ± 0.5; p < 0.0001); quality-of-life (50.9 ± 11.7 to 21.8 ± 13.4; p < 0.0001); and distance walked in six minutes (355 ± 136 m to 443 ± 110 m; p = 0,003). The number of ventricular premature beats in 24 hours tended to increase (5,322 ± 4,977 to 7,441 ± 7,955; p = 0,062), but without increase in ventricular tachycardia episodes (61 ± 127 to 54 ± 127; p = 0.27). CONCLUSIONOur data demonstrate for the fi rst time that intracoronary injection of bone marrow mononuclear cells is feasible and suggest that it may be potentially safe and effective in patients with CHF due to Chagas disease.

Incidence of Ventricular Arrhythmias after Stem Cell Therapy in Patients with Chagas Cardiomyopathy

“…The present study found no increase in numbers of isolated ventricular premature beats compared with the CG, in agreement with studies by Vilas Boas et al 4,8 . The studies by Vilas Boas et al 4,8 had a patient profile similar to ours.…”

“…The studies by Vilas Boas et al 4,8 had a patient profile similar to ours. We studied 28 chagasic patients in functional class III and IV of the New York Heart Association (NYHA).…”

“…We studied 28 chagasic patients in functional class III and IV of the New York Heart Association (NYHA). Vilas Boas et al 4,8 , similarly to this study, evaluated patients with advanced-stage cardiomyopathy and demonstrated the safety regarding the genesis of arrhythmias in this group of patients.…”

Therapy of Chagas Disease: Implications for Levels of Prevention

“…For instance, cardiac transplant is a procedure that has been applied and has demonstrated clinical benefit in some patients with terminal heart failure [78]. Stem cell transplant is a new therapy applied to produce cardiac regeneration through distinction or increase heart myocytes or neovascular proliferation in patients in the final stage of congestive heart failure [79–81], but the results are still insufficient on Chagas disease, and there is no consensus about its efficacy [80]. …”

A Utilização de Células-tronco em Doenças Cardíacas: Apresentação dos Estudos Publicados no Brasil

“…Apesar das divergências e discrepâncias de um estudo para o A cardiomiopatia chagásica implica em alterações das fibras cardíacas como hipertrofia de miócitos, miocardite crônica e fibrose, causadas devido à infecção por Trypanosoma cruzi, que podem levar à insuficiência do músculo cardíaco (BENVENUTI; GUTIERREZ, 2007). No estudo de Vilas-Boas et al (2006) pacientes portadores de insuficiência cardíaca (IC) devido à doença de Chagas, com fração de ejeção ventricular menos que 40% e em uso de terapia crônica farmacológica para IC, foram submetidos à injeção de células-tronco mononucleares autólogas. Antes do transplante celular os pacientes apresentavam função ventricular com fração de ejeção baixa, porém, após um mês do procedimento houve uma melhora significativa da função ventricular, além de correção do nível sérico de sódio, ambos os resultados se mantiveram durante os dois meses de observação inicial do estudo.…”