Abstract 15956: Comparison of Clinical Effects of Transedocardial vs. Intracoronary Stem Cell Transplantation in Dilated Cardiomyopathy
Background. We directly compared clinical efficacy of intracoronary and transendocardial CD34+ stem cell transplantation in patients with non-ischemic 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 18 hours after the procedure. Patients were followed for 6 months.
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 (105±31 x 106 in the TE group vs. 103±27 x 106 in the IC Group, P=0.62). At 18 hours after tijection myocardial retention rates were significantly higher in TE Group (19.2±4.8 %) than in IC Group (4.4±1.2 %, P<0.01). During follow-up LVEF improved more in TE Group (+8.1±4.3 %) than IC group (+4.2±2.3 % , P=0.03). The same was true for 6-minute walk test distance (+125±33 m in TE group vs. +86±13 m in IC group, P=0.03) and NT-proBNP (-628±211 pg/ml vs. -315±211 pg/ml, P=0.04). In both groups we found no change in LVEDD (-0.12±0.18 cm in TE vs. -0.08±1.1 cm in IC, P=0.89), TNF-alpha (4.5±2.3 pg/ml vs. 3.7±2.3 pg/ml, P=0.38) or IL-6 (5.1±4.2 pg/ml vs. 4.3±2.7 pg/ml, P=0.36).
Conclusions. In patients with DCM transendocardial stem cell transplantation is associated with higher myocardial retention rates and superior improvement in ventricular function, NT proBNP levels and exercise capacity than intracoronary route. Therefore, it may represent the prefered method of stem cell transplantation in this patient cohort.
- © 2012 by American Heart Association, Inc.