Author + information
In pre-clinical models of stem cell therapy, early myocardial cell engraftment predicted late cardiac functional recovery. We sought to analyze the effect of myocardial homing of CD34+ cells on clinical outcome in patients with non-ischemic dilated cardiomyopathy (DCM).
In 94 patients with non-ischemic DCM, peripheral blood stem cells were mobilized by daily subcutaneous injections of filgrastim. CD34+ cells were collected via apheresis and labeled with technetium. Cells were injected either intracoronary in the artery supplying segments of reduced myocardial viability (n=53), or transendocardially in the target areas defined by electro-anatomical mapping (n=41). Nuclear imaging for quantitation of myocardial homing of labeled cells was performed 18 hours after the procedure. Good homing was predefined as measured activity greater than median value of the general activity. Patients were followed for 1 year.
At baseline, patients with good (>median, group A) and poor (≤median, group B) homing did not differ in age, gender, left ventricular ejection fraction (LVEF), or plasma levels of creatinine or NT-proBNP. The number of mobilized CD34+ cells used for injection was comparable in both groups (98±56 million in group A vs. 101±38 million in group B, P=0.73). Transendocardial cell injection was more frequent in group A (62%) than in group B (32%, P=0.01). At year 1, LVEF improved more in group A (+6.2±2.8 %) than group B (+2.7±1.7 %, P=0.01). The same was true for 6-minute walk test distance (+101±21 m in group A vs. +46±11 m in group B, P=0.01) and levels of NT-proBNP (−733±2411 pg/ml vs. −115±123 pg/ml, P=0.006). In both groups, we found no significant change in LVEDD (−0.08±0.16 cm in group A vs. −0.06±0.10 cm in group B, P=0.70).
In patients with non-ischemic DCM, higher myocardial CD34+ cell homing is associated with superior improvement in ventricular function, NT-proBNP levels, and exercise capacity. This suggests that early myocardial cell engraftment translates into long-term clinical benefit in this patient cohort.
Oral Contributions South, Room 104
Sunday, March 10, 2013, Noon-12:15 p.m.
Session Title: Joint Session of the Heart Failure Society of America and American College of Cardiology
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 925-8
- 2013 American College of Cardiology Foundation