Abstract 15190: Comparison of Clinical Effects Following Multi-site versus Single-site CD34+ Cell Injections in Patients With Ischemic Cardiomyopathy
Introduction: We investigated the relation between the distribution of transendocardial CD34+ cell injections and clinical response to cell therapy in patients with ischemic cardiomyopathy (ICM).
Methods: Of 30 patients with ICM, 15 were randomized to single-site transendocardial CD34+ cell injection (Group A) and 15 patients recieved cell injections in multiple sites (Group B). 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 electroanatomical mapping (unipolar voltage ≥9 mV and linear shortening <6%). All patients received 20 injections of stem cell suspension (0.3 ml each) and were followed for 6 months.
Results: At baseline, the two groups did not differ in age (55.9±5.7 years in Group A vs. 57.4±6.6 years in Group B, P=0.48), gender (male: 88% vs. 87%, P=0.85), NYHA functional class (3.4±0.5 vs. 3.1±0.5, P=0.1), LVEF (24.6±4.5% vs. 26.1±7.5%, P=0.47), serum creatinine (83±28 μmol/L vs. 88±18 μmol/L, P=0.51), bilirubin (21.3±12.9 μmol/L vs. 15.1±7.6 μmol/L, P=0.11), or NT-proBNP levels (2044±1836 pg/mL vs. 3598±3921 pg/mL, P=0.14). Both groups received similar numbers of CD34+ cells (81.9±66.7 million in Group A vs. 102.3±71.5 million in Group B, P=0.46). Furthermore, we found no difference in the electroanatomical parameters between the groups (mean unipolar voltage 6.9±1.9 mV in Group A vs. 7.9±2.0 mV in Group B; P=0.16; number of scar segments 6.5±2.8 vs. 5.5±2.4, P=0.29; number of hibernating segments 2.0±2.0 vs 1.5±1.2, P=0.35). The mean number of injection sites in Group B was 2.4±0.6. When compared to Group A, patients with Group B dispayed superior improvement in LVEF (+5.0±7.5% in Group A vs. +12.4±10.7% in Group B, P=0.03) and NT-proBNP (-135±1301 pg/mL vs. +1469±2501 pg/mL, P=0.05). No significant inter-goup difference was observed in 6-minute walk test distance (+9.4±210 m vs. +29.3±165.6 m, P=0.78).
Conclusions: When performing transendocardial cell injections of CD34+ cells in patients with ICM, targeting only one area of the myocardium appears to be associated with inferior clinical response when compared to the injection strategy that covers multiple myocardial segments.
Author Disclosures: G. Poglajen: None. G. Zemljic: None. M. Sever: None. M. Cukjati: None. F. Haddad: None. J.C. Wu: None. B. Vrtovec: None.
- © 2014 by American Heart Association, Inc.