Abstract 15973: Transendocardial Stem Cell Transplantation in Patients with Ischemic vs. Non-Ischemic Cardiomyopathy
Background. We directly compared clinical efficacy of transendocardial transplantation of CD34+ stem cells in patients with ischemic and non-ischemic cardiomyopathy.
Methods. Of 56 NYHA class III chronic heart failure patients with LVEF 20-40%, 28 had ischemic (ICM) and 28 non-ischemic (DCM) cardiomyopathy. In both groups peripheral blood stem cells were mobilised by subcutaneous injections of filgrastim; CD34+ cells were collected via apheresis and labelled with technetium. 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; clinical responders were defined as patients with LVEF improvement, increase in exercise capacity and decline in plasma NT-proBNP.
Results. At baseline, the groups did not differ in age, gender, LVEF, plasma levels of NT-poBNP or creatinine. During procedure there was no difference in number of CD34+ cells used for injection (105±65x 106 in ICM vs. 96±70 x 106 in DCM, P=0.41), stem celll viability (93±10 % vs. 91±11 %, P=0.39) and myocardial cell retention rates.(11.1±5.1 % vs. 10.3±4.3 %, P=0.56). During follow-up LVEF improved more in DCM (+7.3±3.8 %) than ICM group (+3.1±2.1 % , P=0.02). The same was true for 6-minute walk test distance (+108±21 m in DCM vs. +46±13 m in ICM, P=0.03). In both groups we found similar decline in NT-proBNP levels (-478±312 pg/ml in DCM vs. -215±303 pg/ml in ICM, P=0.22) and and LVEDD (-0.23±0.12 cm in DCM vs. -0.18±0.14 cm in ICM, P=0.68). The number of clinical responders was significantly higher in DCM (71%) than ICM group (36%, P=0.02).
Conclusions. Despite similar myocardial stem cell retention rates, transendocardial CD34+ stem cell transplantation appears to have more pronounced effects on ventricular function, exercise capacity and clinical improvement in non-ischemic than in ischemic cardiomyopathy.
- © 2012 by American Heart Association, Inc.