Abstract 1893: Inducible Ischemia is Predictive for Functional Improvement and Associated with Reduced Mortality in Patients with Chronic Ischemic Heart Failure Receiving Intracoronary Progenitor Cell Therapy
Intracoronary infusion of bone marrow-derived progenitor cells (BMC) was shown to be associated with modestly improved cardiac function in patients (pts) with chronic post-infarction heart failure (CHF). In order to identify predictors for an improvement of LVEF after 3 months, we assessed a potential role of inducible ischemia (ii) as evidenced by the presence of angina and ST-segment deviation during balloon occlusion for i.c. BMC infusion in a consecutive series of 97 pts with CHF. Pts with ii (n=76) were younger (median age: 61 vs. 67 yrs, p=0.005) and had a more recent MI (median 38 months vs. 103 months, p=0.02) compared pts without ii (n=21). Baseline LVEF and NT-proBNP serum levels did not differ between both groups. Improvement in LVEF was significantly greater in pts with ii (relative 6.4±2%) compared to pts without ii (−0.2±15%; p <0.05). Multivariate analysis identified ii (p=0.01) and higher systolic blood pressure (SBP; p=0.004) as independent predictors of LVEF improvement. Importantly, ii at baseline prior to BMC therapy was associated with a significantly reduced mortality during 2 years follow-up (figure⇓). By Cox regression analysis, the absence of ii, elevated NT-proBNP levels and lower SBP independently predicted mortality within 2 years in pts undergoing BMC therapy. In pts with post-infarction heart failure receiving i.c. BMC therapy, inducible ischemia at the time of BMC administration is an independent predictor for improved cardiac function at 3 months, and reduced mortality during 2 years follow-up. Thus, the presence of viable, ischemic myocardium may convey a survival benefit in pts with CHF undergoing i.c. BMC therapy.