Abstract 15246: High Levels of Nt-probnp Are Associated With Poor Clinical Response to CD34+ Cell Therapy in Patients With Non-ischemic Dilated Cardiomyopathy
Background: Although CD34+ cell therapy has been associated with favorable clinical response in non-ischemic dilated cardiomyopathy (DCM), individual patient response is variable. We sought to identify predictors of clinical response in this patient population.
Methods: We pooled the data on 77 consecutive patients with DCM who underwent transendocardial CD34+ cell transplantation as a part of several stem cell studies performed at our center from January 2011 until December 2013. All patients received 5-day stimulation with G-CSF; CD34+ cells were selected with apheresis and injected transendocardially guided by electroanatomical mapping. Patients were followed for 6 months and good clinical response was defined as an increase of left ventricular ejection fraction (LVEF) ≥5%.
Results: During follow-up, 1 patient died of sudden cardiac death and 1 underwent urgent heart transplantation. Of remaining 75 patients, 36 (48%) had good clinical response and 39 (52%) were poor responders. At baseline, the two groups did not differ in age (56±10 years in good responders vs. 57±9 in poor responders, P=0.48), gender (male: 83% vs. 79%, P=0.48), LVEF (28.5±7.4% vs. 30.5±7.4%, P=0.20), left ventricular end-diastolic dimension (6.6±0.7 cm vs. 6.7±0.7 cm, P=0.38), creatinine (85±21 μmol/L vs. 93±23 μmol/L, P=0.12), bilirubin (17.6±10.3 μmol/L vs. 18.5±7.4 μmol/L, P=0.68), or hemoglobin levels (145±11 g/l vs. 145±9 g/l, P=0.73). However, the levels of NT-proBNP before cell therapy were significantly higher in poor responders (3036±4246 pg/mL vs. 1380±1626 pg/mL in good responders, P=0.03). The number of responders declined progressively with each quartile of increase in NT-proBNP (78% in Q1, 44% in Q2, 39% in Q3, and 33% in Q4). Similarly, the number of mobilized CD34+ cells was significantly lower in patients with higher NT-proBNP levels (123±38 x106 in Q1, 107±32 x106 in Q2, 75±41 x106 in Q3, and 64±31 x106 in Q4). On multivariate analysis, the increase in NTproBNP (Q4) was an independent correlate of poor clinical response at 6 months (P=0.04).
Conclusions: High levels of NT-proBNP appear to be associated with impaired bone marrow CD34+ cell mobilization and poor clinical response to CD34+ stem cell therapy in patients with non-ischemic DCM.
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.