Abstract 17230: Effects of Transendocardial CD34+ Stem Cell Transplantation in Patients With Ischemic Cardiomyopathy
Background: We investigated clinical effects of transendocardial transplantation of CD34+ stem cells in patients with ischemic cardiomyopathy (ICM).
Methods: In a prospective cross-over study, we enrolled 33 ICM patients with NYHA class III heart failure and LVEF<40%. In Phase 1, patients were treated with optimization of medical therapy for 6 months. Thereafter, all patients underwent transendocardial CD34+ cell transplantation. Peripheral blood CD34+ cells were mobilized by G-CSF, collected via apheresis, and injected transendocardially in the areas of hibernating myocardium as defined by NOGA electromechanical mapping (unipolar voltage ≥9 mV and linear shortening <6%). Patient were followed for 6 months after the procedure (Phase 2).
Results: Of 33 patients enrolled, 2 died during Phase 1 and none during Phase 2. The remaining 31 patients were 85% male, their age was 57±6 years, 9 (29%) had diabetes, their creatinine and bilirubine levels were 89±22 μmol/L and 17.9±9.5 μmol/L, respectively. In Phase 1, we found no significant change in LVEF (from 25.2±6.2 % to 27.1±6.6 %; P=0.23), LVEDD (from 6.1±0.66 cm to 6.9±1.1 cm; P=0.27), NT-pro-BNP (from 3,322±3,411 pg/mL to 3,737±5,143 pg/mL; P=0.71), or 6-minute walk distance (from 373±68 m to 411±116 m; P=0.17). In contrast, in Phase 2 there was a significant improvement in LVEF (from 27.1±6,6 % to 34.7±10.9 %; P=0.001), increase in 6-minute walk distance (from 411±116 m to 481±130 m; P=0.001), and a decrease in NT-proBNP (from 3,737±5,143 pg/mL to 2,525±3,451 pg/mL; P=0.04). No significant change in LVEDD was found (from 6.9±1.1 cm to 7.1±3.5 cm; P=0.72). The average number of injected CD34+ cells was 90.6±7.5 x106. Patients who were able to generate more cells after G-SCF stimulation received higher doses of CD34+ cells, and had a better clinical response in Phase 2 (109.1±69.7 x106 cells in good responders vs. 40.5±27.5 x106 cells in poor responders; P=0.01).
Conclusions: Transendocardial CD34+ stem cell transplantation leads to improved left ventricular function, decreased NT-proBNP levels, and better exercise capacity in patients with ICM. Thus, it appears to be superior to unselected bone-marrow cell therapy in this patient cohort.
- © 2013 by American Heart Association, Inc.