Abstract 16155: Identification of Clinical Factors in Cell Therapy Trials That Determine Recovery versus Deterioration of LV Function Following STEMI
Background: The recovery of LV function following STEMI may be highly variable due to resolution of myocardial stunning and other factors. The identification of clinical factors that may be predictive of either recovery or deterioration of LV function would be valuable in identifying patients who may benefit from participation in cell therapy trials.
Methods and Results: To determine these clinical metrics, we analyzed patients in the NHLBI TIME (n= 120) and TIME Pilot Trials (n=40). Patients with Recovery of LV function (Age=56) were identified as those patients with baseline LVEF < 50% measured 3 days post-STEMI that demonstrated the greatest improvement in LVEF measured at 6 months by cardiac MRI (41.3 to 59.2 %), while patients whose LV function deteriorated (Age=53) had the greatest decline in LVEF (47.5 to 35.9 %). All patients were randomized to autologous BMCs or placebo (2:1) within one week following successful primary PCI for anterior STEMI. Both trials were notable for a failure of BMCs to further improve LVEF compared to placebo. Patients with recovery of LV function demonstrated a significant reduction in infarct size over 6-months irrespective of receiving cell therapy or placebo and were more likely to have pre-infarction angina. Patients whose LV function deteriorated had a similar infarct size percentage but greater LV and infarct mass and peak CKMB at baseline. Patients with deterioration of LV function experienced marked increases in LV volumes over 6 months while recovered patients demonstrated a marked decrease in LVESV (83 to 65 ml, vs. 90 to 135 ml; p < 0.001) and LVEDV.
Conclusion: Deterioration of LV function following STEMI is associated with an increased LV mass at baseline and a failure to significantly reduce infarct size over 6 months. In contrast, many patients with reduced LV function at baseline will show significant recovery of LV function by 6 months that is associated with marked reduction in infarct size irrespective of receiving cell therapy.
Author Disclosures: J.H. Traverse: Research Grant; Modest; NHLBI. Research Grant; Significant; modest. L. Moye': None. T.D. Henry: None.
- © 2014 by American Heart Association, Inc.