Abstract 3979: Intracoronary Stem Cell Transplantation in Dilated Cardiomyopathy: The Results of SC-DCM Trial
Background. We prospectively investigated effects of intracoronary transplantation of bone-marrow derived stem cells in patients with dilated cardiomyopathy.
Methods and Results. Of 55 patients with dilated cardiomyopathy, 28 were randomized to intracoronary transplantation of autologous CD34+ cells (SC Group), and 27 received no stem cell therapy (Controls). In SC Group peripheral blood stem cells were mobilised by daily subcutaneous injections of G-CSF; 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. At baseline, the two groups did not differ in age, gender, left ventricular ejection fraction (LVEF), or plasma NT-proBNP levels. During 1-year follow-up 5 patients died and 5 underwent heart transplantation. The combined mortality/heart transplantation rate was significantly lower in the SC Group (2/28, 7%) than in Controls (8/27, 30%) (P=0.03). Heart transplantation-free survival as evaluated by Kaplan-Meier analysis was 3.8-times higher in the SC group than in Controls (P=0.03) and stem cell therapy was the only independent predictor of outcome on multivariate analysis (P=0.04). At 1 year, stem cell therapy was associated with a significant increase in LVEF (from 25.5±7.5% to 30.1±6.7%; P=0.03), increase in 6-minute walk distance (from 359±104 m to 485±127 m; P=0.001), and decrease in NT-proBNP (from 2069±1996 pg/ml to 1037±950 pg/ml; P=0.01).
Conclusions. Intracoronary stem cell transplantation is associated with improved survival, increased LVEF and exercise capacity, and decreased NT-proBNP levels in patients with dilated cardiomyopathy.