eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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vol. 18
Original paper

Trans-endocardial delivery of progenitor cells to compromised myocardium using the “needle technique”and risk of myocardial injury

Leszek Drabik
1, 2
Adam Mazurek
Monika Dzieciuch-Rojek
Lukasz Tekieli
Łukasz Czyż
Ewa Kwiecień
Aleksandra Kułaga
Aleksandra Mikunda
Jakub Chmiel
Wojciech Płazak
1, 5
Paweł Rubiś
1, 5
Piotr Musiałek
1, 5

Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
Department of Cardiology and Internal Medicine, Ludwik Rydygier Memorial Specialized Hospital, Krakow, Poland
Jagiellonian University Medical College, Krakow, Poland
Adv Interv Cardiol 2022; 18, 4 (70): 423–430
Online publish date: 2022/11/14
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Recent analysis from CHART-1 study indicated that the therapeutic effects of trans-endocardial cardiopoetic cell transplantation in chronic ischemic heart failure (iCHF) may be lost with an increasing number of injections perfomed to deliver therapeutic cells. Aim: To evaluate global and regional contractility and diastolic function of the left ventricle of patients with iCHF who received trans-endomyocardial cardiopoietic stem cells (CSCs) delivery or sham procedures.

Material and methods
The study included patients (mean age: 60.8 ±7.1 years) with iCHF (left ventricular ejection fraction (LVEF) < 35%) and a history of hospitalization for worsening heart failure within 12 months despite optimal medical therapy. The patients underwent transmyocardial CSCs transplantation using perforated needle technique or a sham procedure. The wall motion score index (WMSI), LVEF, transmitral E-velocity, E-wave deceleration time, E/A-ratio, and E/e'-mean value were measured with two-dimensional echocardiography on days 1 and 30.

A total of 170 segments were analyzed, including 48 targeted segments where 92 injections of 0.5 ml of CSCs were performed. In the transendocardial injections cohort, a decrease in regional contractility was observed in 30.6% (26/85) and 18.9% (16/85) of the segments on days 1 and 30, respectively. This was accompanied by an increase in WMSI by 0.32 ±0.06 and 0.19 ±0.18 (day 1, p = 0.02, day 30, p = 0.03) and a reduction in LVEF (–3.15 ±1.23%, p = 0.065).

Transendocardial injections performed to deliver therapeutic cells were associated with myocardial injury. This adverse effect remained, albeit at a lesser degree, at 30-days. Mechanical injury with trans-endocardial delivery of progenitor cells using the “needle technique” may counterbalance, at least in part, any cell-related benefit(s).


heart failure cell therapy, stem cells, transmyocardial cell transplantation, treatment outcome, ventricular function, wall motion score index

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