Abstract 13881: Cardiac Progenitor Cell Infusion in Patients With Univentricular Heart Diseases in Heart Failure With Preserved Ejection Fraction
Backgrounds: The clinical outcomes of heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF) after staged palliations in patients with univentricular heart disease remain unknown as is the question whether cardiosphere-derived cell (CDC) transfer may have impact on either type of cardiac dysfunction.
Purpose: We sought to characterize the heart failure patients, include HFrEF and HFpEF, with single ventricular physiology and investigate the clinical responsiveness after CDC therapy.
Methods: Forty-three patients, aged 2.2±1.4 years, undergoing staged shunt procedures were divided into two groups by cardiac function based on cMRI (HFrEF: EF<40%, n=30; HFpEF: EF>40%, n=13).
Results: Compared with HFpEF patients, HFrEF patients showed increased cardiac volume (P=0.02) and mass index (P=0.04), those were associated with reduced global circumferential strain in HFrEF compared with HFpEF (P=0.0004). There was no difference in the incidence of late gadolinium enhancement detected by cMRI in both groups (20% in HFrEF and 15% in HFpEF). When patients underwent staged shunt procedures, HFpEF group had significant reduction in EF (P=0.03) and atrial strain (P=0.047), resulting in increase in Tei index 1 month after palliation (P=0.02). To investigate whether CDC infusion may affect the cardiac function in these two types of HF, patients were subjected to receive CDC injection 1 month post palliation. In contrast to HFpEF group, HFrEF patients demonstrated a marked improvement in EF (P=0.0006), right ventricular elastance (P=0.0005) 3 months after CDC infusion. Similarly, diastolic function improvements were found in CDC-treated HFrEF group but HFpEF patients as shown by increased atrial fractional area change (P=0.01) and reduced E-wave/e’sr (P=0.049). However, patients with HFpEF showed no improvement in diastolic function but significantly reduced dP/dt at 3 months (P=0.04). These beneficial effects by CDCs could not be seen in remaining 20 patients who were assigned to treat as palliation alone without CDC injection.
Conclusions: HFpEF is common in univentricular heart diseases and that may have early perioperative right ventricular dysfunction and could be CDC therapy-resistant leading to latent heart failure.
- cell therapy
- single ventricle
- heart failure with preserved ejection fractio
- congenital heart disease
- diastolic dysfunction
Author Disclosures: D. Ousaka: None. T. Goto: None. S. Ishigami: None. S. Ohtsuki: None. S. Kasahara: None. S. Sano: None. H. Oh: None.
- © 2015 by American Heart Association, Inc.