Abstract 14931: Electromechanical Assessment of Myocardial Function is Associated With Improvement in Ejection Fraction in Patients Treated With Autologous Stem Cell Therapy for Ischemic Cardiomyopathy
Introduction: Endomyocardial mapping (NOGA®) allows “real-time” assessment of electrical activity (voltage) within the left ventricle. Currently used to direct intramyocardial injections of stem cells, its ability to predict outcomes in patients with reduced ejection fraction (EF) has not been previously reported. We hypothesized an association between unipolar voltage (UpV) by endomyocardial mapping and change in ejection fraction and walking distance in patients with ischemic cardiomyopathy.
Method: We evaluated a cohort of 86 CAD patients enrolled in the FOCUS-CCTRN cell therapy trial. All had heart failure/and or angina, EF < 45%, a defect by SPECT and had UpV data available prior to autologous, intramyocardial bone marrow mononuclear cell treatment or placebo. Patients underwent mapping and then 14-15 injections within ischemic, viable myocardium (defined by SPECT) with injection site UpV ≥6.9 mV.
At 6 months, change in left ventricular end systolic volume (LVESV), maximal oxygen consumption, reversibility by SPECT, change in EF, and walking distance were examined according to baseline UpV data.
Results: The average injection site UpV was 9.7mV (SD
2.0mV) with a mininum of 5.5mV and maximum of 18.6mV.
In simple linear regression modeling, injection site UpV did not correlate with changes in walking distance, LVESV or reversible SPECT defect. However, UpV was significantly associated with improvement in EF (p-value 0.038). For every 2mV increase in UpV, patients exhibited a 1.3 greater absolute increase in EF from baseline to six months. This association remained significant after adjustment for age, CD34/CD133 counts and cell therapy treatment. Importantly, based on multiple linear regression analyses, UpV and CD34 levels were significantly associated with improvement in EF (p-value 0.030 and p-value 0.014 respectively).
Conclusion: In this analysis, average injection site UpV for intramyocardial delivery of autologous BMCs, in addition to CD34 levels, was associated with an improvement in EF following therapy for ischemic cardiomyopathy. Electromechanical ventricular assessment, specifically UpV, may predict improvement in EF after angiogenic therapy.
- © 2013 by American Heart Association, Inc.