Abstract 1860: Autologous Intracoronary Stem Cell Transplantation Improves Cardiac Function and Exercise Capacity In Patients with End-Stage Dilative Cardiomyopathy
Objective. In a prospective, randomized study we investigated the effects of intracoronary transplantation of bone marrow derived stem cells in patients with end-stage dilative cardiomyopathy.
Methods. Of 20 patients with dilative cardiomyopathy who were listed for heart transplantation, 10 were randomized to receive intracoronary transplantation of autologous CD34+ cells (SC Group), and 10 received no stem cell therapy (Controls). In the SC Group peripheral blood stem cells were mobilised by daily subcutaneous injections of filgrastim; CD34+ cells were collected via apheresis and labelled with technetium. Patients underwent myocardial perfusion scintigraphy for myocardial viability assessment and the collected CD34+ cells were injected intracoronary in the artery supplying the segments of reduced tracer accumulation.
Results. At baseline, the two groups did not differ in age, gender, left ventricular ejection fraction (LVEF), plasma TNF-alpha levels, QT variability, QTc interval, or concurrent medications. The average number of intracoronary transplanted CD34+ cells was 117±17 million. In the SC group we found a significant thickening of target ventricular wall 1 month after transplantation (from 1.1±0.2 cm to 1.3±0.2 cm; P=0.04). At the same time we found an improvement of LVEF in the SC Group (from 23.7±5.5% to 32.2±6.8%; P=0.01), but not in the Controls (from 24.1±5.2% to 25.1±7.1%; P=0.42). Similarly, we found an increase in 6-minute walk distance only in the SC Group (from 351±123 m to 431±78 m; P=0.02 vs. from 355±110 m to 345±98 m in Controls; P=0.54). Plasma TNF-alpha levels in the SC Group showed a trend to decrease (from 4.5±3.5 pg/ml to 3.1±2.2 pg/ml; P=0.17). Stem cell transplantation was not associated with any significant changes in QT variability (QT Variability Index: from −0.53±0.67 to −0.47±0.54; P=0.46) or QTc interval duration (from 482±56 msec to 474±48 msec; P=0.28).
Conclusions. Transcoronary autologous CD34+ transplantation appears to increase left ventricular wall thickness, improve cardiac function and exercise capacity in patients with end-stage dilative cardiomyopathy, without significantly affecting the electrophysiological properties of ventricular myocardium.