Abstract 12881: Intracoronary Versus Transendocardial Stem Cell Transplantation in Patients With Dilated Cardiomyopathy
Background. We directly compared efficacy of intracoronary and transendocardial transplantation of CD34+ stem cells in patients with dilated cardiomyopathy (DCM).
Methods. Of 40 patients with DCM, 20 were randomized to intracoronary transplantation of CD34+ cells (IC Group), and 20 received transendocardial stem cell therapy (TE Group). In both groups peripheral blood stem cells were mobilised by daily subcutaneous injections of filgrastim; CD34+ cells were collected via apheresis and labelled with technetium. In IC group patients underwent myocardial perfusion scintigraphy and CD34+ cells were injected intracoronary in the artery supplying segments of reduced viability. In TE Group electromechanical mapping was used to identify viable myocardium and transedocardial injectons in the target areas were performed with NOGA catheter. Nuclear imaging for quantitation of myocardial retention rates of labeled cells was performed at 2 and 18 hours after the procedure.
Results. The two groups did not differ in age, gender, left ventricular ejection fraction (LVEF), or plasma levels of NT-poBNP, TNF alpha and IL-6. The number of mobilized CD34+ cells used for injection was comparable in both groups (108±34 x 106 in the TE group vs. 113±27 x 106 in the IC Group, P=0.56). At 2 hours after the procedure myocardial retention rates were significantly higher in the TE Group (38.5±8.5%) than in IC Group (7.3±1.5%, P<0.001). Similar results were found at 18 hours: 29.3±6.1% in TE Group vs. 5.3±1.3% in IC Group (P<0.001). At this time, the two groups did not differ in plasma levels of troponin I (0.21±0.08 ng/ml in the TE Group vs. 0.11±0.03 ng/ml in the IC Group, P=0.12), TNF-alpha (4.3±2.1 pg/ml vs. 3.7±2.3 pg/ml, P=0.32), IL-6 (4.7±3.1 pg/ml vs. 4.3±2.7 pg/ml, P=0.46), QTc Interval (481±32 msec vs. 478 ±27 msec, P=0.70) or QT variability index (-0.48±0.21 vs. -0.51±0.23, P=0.58).
Conclusions. In patients with DCM transendocardial stem cell transplantation leads to higher myocardial retention rates than intracoronary route. It does not appear to be associated with increased risk of myocardial necrosis, inflammation or electophysiological instability and may therefore represent the preferred method of stem cell delivery in this patient cohort.
- © 2011 by American Heart Association, Inc.