| Background and objective:Nowadys, acute myocardial infarction (AMI) has become a chief offender to thehuman being life. Recently the mortality of AMI has been drawdown significantly because of cardiovascular drugs therapy and percutaneous coronary interventional therapy, but the morbility and mortality of chronic heart failure(CHF) after AMI is still very high up to now and continuously increase. Large area myocardial necrosis after AMI will inevitably lead to the change of systolic and diastolic stress, and inefficient function, further heart remodeling and heart failure. After AMI, the most frequent complication is heart failure. Dilated cardiomyopathy(DCM) is the most common cardiomyopathy and it' s morbility ranks the first in cardiomyopathy. Heart enlargement and cardiac murmur arrhythmia congestive heart failure are main clinical appearance of dilated cardiomyopathy and it' s main causes of death are malignant arrhythmia and cardiogenic sudden death. Heart transplant is considered as the best method to treat the patients who remain refractory heart failure at present. However, this approach is limited by problems such as side effects of immunological rejection and immunosuppression, donor deficiency, disparity between the donors and recipients and so on. So in order to decrease mortality of heart failure patients after AMI and increase quality of life and survival rate of myocardium infarction patients , we must try our best to reduce necrosis of myocardium to save more survival myocardium as well as to increase the number of efficient working myocardium. Recently because the cell therapy can replace, repair or enhance injured function of tissues and organs, it has become a new therapy measure to many diseases. Bone marrow stem cells (BMCs) transplantation is a sort of cell therapy. Many researches have proved that stem cell has self-renovation and multi-differentiation ability, and can trans-differentiate into many other kinds of tissues and cells. Many animal and clinical tests have proved that BMCs can repair the injured myocardium of AMI patient. Animal studies and H2 phase-1 clinical trials have demonstrated the safety, efficacy and potential of clinical application in stem cell transplantation.Moreover,it have achieved exciting research results. Quality of life is a extensive concept which include physiology and it' s degree. It can generally reflect health of human being as a index which can reflect physical function , psychologic status,and social adaptation ability.Whereas,it has not been reported up to now about quality of life follow up for at least half of one year in patients who had been transplanted autologous bone marrow stem cells. Our previous study had drawn the conclusion that it is effective for autologous bone marrow stem cells to recover ischemic myocardium and improve cardiac function. On this basis,we adopted self contrast and interclass contrast to follow up quality of life about 87 cases for half year who had been transplantated autologous bone marrow stem cells. These patients included acute myocardialinfarction(AMI),old myocardial infarction(OMI),and Dilated cardiomyopathy(DCM).We randomly applied SF-36 questionnaire to investigate quality of life score by the method of telephone follow up and face to face talk and roughly analyzed the death cases. In addition, we utilized cardiac function by NYHA class and 6 minutes walk test to evaluate clinical effect and quality of life improvement in patients with heart failure who had been transplantated autologous bone marrow stem cells.Patients and Methods:From 26 july of 2003 when we used autologous bone marrow stem cells to treat acute anterior myocardial infarction accompanied with heart failure for the first time to december of 2006,we completed about three hundred cases in which some patients were transplantated for two or three times. We randomly finished questionnaire investagation for 87 transplantation group and 79 control group by the method of telephone follow up and face to face talk who were all eligible patients. Trial group included 34 Dilated cardiomyopathy, 33 old myocardial infarction, 20 acute myocardial infarction and control group included 34 Dilated cardiomyopathy, 33 old myocardial infarction, 20 acute myocardial infarction. LVEF of all patients were less than 45%. One day before cells therapy, bone marrow of trial group was taken 80- 100ml from the iliac crest and mononuclear cells were isolated by Ficoll density separation with Lymphocyte Separation Medium.BM-MNC were counted and identified by flow cytometer.During procedure, we injected autologous bone marrow stem cells to left and right coronary through guiding catheter or angiography catheter. For all patients,we followed quality of life at least half of one year with SF-36 questionnaire and contrasted between two groups, in addition, roughly analyzed the death. Trial group performed self contrast about cardiac function by NYHA class and 6 minutes walk test before operation,half year and one year after operation. Statistical analysis was performed with SPSS-13.0 software. Numerical variable was analyzed by independent sample -t-test and categorical variable was analyzed by chi-squared-test. P<0.05 was considered statistically significant.Results:1.The mortality of trial group was 10.3%; The mortality of control group was 11.4%. We did not find statistical significance between two groups by chi-squared-test2.The effective power of trial group was 73.6%; The effective power of control group was 62.0%. We found statistical significance between two groups by chi-squared-test (P<0.05).3.The score of general health restriction of physical function,mental health in trial group with DCM was 63.0±21.5. 26.7±14.2 83.1±15.2 respectively and 47.9±24.8 15.6±10 69.7±20.6 in control group which all had statistical significance (P<0.05).4. The score of restriction of physical function,body pain in trial group with OMI was43.8±29 84.6±21.6 respectively and 14.9±13.2, 67.0±25.2 in control group which all had statistical significance (P <0.05). 5. The score of general health ,social function,restriction of physical function,vitalis in trial group with AMI was 76.9±23.4 86.5±22.8,59.7±38.5,78.8±16.5 respectively and 47.5±24.4 68.2±24.9 27.6±17.4. 56.7±18.9 in control group which all had statistical significance (P <0.05).The total score was 81.8±18.5 in trial group with AMI and 66.2±15.6 in control group. They also had statistical significance (P<0.05).6. Evaluation of cardiac function by NYHA class: The NYHA class of AMI ,OMI, DCM in trial group before procedure was 2.03±0.38 2.57±0.42. 2.65±0.51 respectively;half year after transplantation was 1.94±0.31, 2.05±0.38. 2.11±0.57 respectively;one year after transplantation was 1.90±0.30. 2.02±0.38 2.09±0.45 respectively. It showed the NYHA class of AMI before procedure was obviously lower than OMI and DCM ,but OMI had no statistical significance compared with DCM. Half year after transplantation, the NYHA class of OMI and DCM showed statistical significance(P<0.05),but AMI showed no statistical significance(P>0.05).One year after transplantation,cardiac functionof all cases had been improved furthermore,but it showed no statistical significance compared with that of half year. Through our contrast study in trial group,we found the NYHA class of OMI and DCM decreased significantly(P <0.05) in half year after transplantation and improved further one year after transplantation.The NYHA class of AMI reduced to some extent.7.Follow up result of 6 minutes walk test :6 minutes walk test of AMI ,OMI ,DCM in trial group before procedure was 315.6±47.1 265.8±45.6 247.2±41.0 respectively;half year after transplantation was 353.5±49.6 348.9±50.1 .. 339.4±48.7 respectively;one year after transplantation was 364.7±52.5 360.2±50.2, 355.9 + 43.9 respectively. It showed 6 minutes walk test of AMI before procedure was obviously better than OMI and DCM, but OMI had no statistical significance compared with DCM. Half year after transplantation, the 6 minutes walk test of OMI and DCM showed statistical significance(P<0.05),but AMI showed no statistical significance(P>0.05).One year after transplantation, 6 minutes walk test of all cases had been improved furthermore,but it showed no statistical significance compared with that of half year. Through our contrast study in trial group,we found the 6 minutes walk test of OMI and DCM improved significantly(P<0.05) in half year after transplantation and improved further one year after transplantation.The 6 minutes walk test of AMI improved to some extent.Conclusions:1. Autologous BM-MNCs transplantation by intracoronary infusion can improve quality of life of patient with AMI significantly.2. Autologous BM-MNCs transplantation by intracoronary infusion can also improve quality of life of patients with DCM and OMI who were succssefully performed PCI to the infarct related artery to some extent.3. Half year after transplantation, the NYHA class of OMI and DCM decreasesignificantly(P<0.05) and improve further one year after transplantation.The NYHA class of AMI reduce to some extent.4. Half year after transplantation, the 6 minutes walk test of OMI and DCM improve significantly(P<0.05) and improve further one year after transplantation.The 6 minutes walk test of AMI improve to some extent.5. Whether Autologous BM-MNCs transplantation by intracoronary infusion in patients with heart failure can reduce mortality and increase incidence of carcinoma,it need long-term follow-up and research of large sample.
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