Abstract 11081: Minute Myocardial Injury as Measured By High-sensitive Troponin T Predicts the Response to Intracoronary Infusion of Bone Marrow-derived Mononuclear Cells in Patients With Stable Chronic Post-infarction Heart Failure - Insights From the TOPCARE-CHD Registry
Cell based therapies are a promising option in pts with chronic post-infarction heart failure (ICM). However, the responses following intracoronary infusion of autologous bone marrow-derived mononuclear cells (BMC) are heterogeneous, which may be related to impaired cell retention in pts with healed MI. Since the development of ultrasensitive tests to measure serum levels of Troponin T (hsTrop) revealed the presence of ongoing minute myocardial injury even in pts with stable ICM, we hypothesized that levels of hsTrop correlate with cell retention and may determine the response to intracoronary BMC application in pts with ICM.
Methods: 135 pts (median age 62 [IQR 56-70] years) with ICM (median NYHA class 2 [2-3]; median baseline NT-proBNP 685 [300-1655] pg/ml) and no substantial impairment of kidney function received intracoronary BMC using the stop-flow technique. Prior to cell application, hsTrop and NT-proBNP were measured, and NT-proBNP as a marker of left ventricular wall stress assessment was repeated at 4 months follow-up.
Results: Pts with elevated hsTrop (> 14ng/ml, n=88) suffered from more severe CHF compared to pts with low hsTrop (<=14 ng/ml; n=47) as evidenced by higher NYHA class (2 versus 3, p<0.01) and NT-proBNP serum levels (467 [243-469] versus 1571 [611-3377] pg/ml; p<0.01). Pts with elevated baseline hsTrop demonstrated a profound and significant (p=0.04) reduction in their NT-proBNP (median delta NT-proBNP -160 [-1208 - 149] pg/ml; relative reduction -21%) in response to BMC administration at 4 months, whereas NT-proBNP remained unchanged in pts without elevated baseline hsTrop (median delta NT-proBNP -1.3 [-116 - 128]; relative change 0.8%). The decrease in NT-proBNP at 4 months was inversely correlated with baseline hsTrop (r=-0.33, p<0.001).
Conclusions: The extent of ongoing minute myocardial damage as measured by serum levels of circulating Troponin at the time of cell administration predicts the reduction of NT-proBNP serum levels at 4 months after intracoronary application of BMC in pts with ICM. These data indicate that beneficial effects of BMC administration on left ventricular remodeling and wall stress are confined to pts with ongoing minute myocardial injury in stable chronic post-infarction heart failure.
- © 2012 by American Heart Association, Inc.