Introduction:
We investigated the effects of transendocardial transplantation of CD34+ stem cells on left ventricular segmental wall motion in patients with ischemic cardiomyopathy (ICM).
Methods:
We performed transendocardial CD34+ cell transplantation in 31 ICM patients with NYHA class III heart failure and LVEF <40%. Peripheral blood CD34+ cells were mobilized by G-CSF, collected via apheresis, and injected transendocardially in the areas of hibernating myocardium as defined by electromechanical mapping (unipolar voltage ≥9 mV and linear shortening <6%). Left ventricular segmental wall motion analysis was evaluated with TomTec software using a 17-segment model of the left ventricle. Of 31 patients enrolled, 85% were male, their age was 57±6 years; their creatinine, bilirubin and NT-proBNP levels were 89±22 μmol/L, 17±9 μmol/L, and 3,322±3,411 pg/mL respectively. The average Syntax score was 27.9±10.5 and the average number of injected CD34+ cells was 90.6±7.5 million. 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, we found a significant improvement in LVEF (from 27.1±6,6% to 34.7±10.9%; P=0.001), left ventricular end-systolic diameter (from 5.3±0.7 cm to 4.9±0.9 cm; P=0.04), and left ventricular end-systolic volume (from 152±45 mL to 135±44 mL; P=0.03). Left ventricular segmental wall motion analysis showed significantly improved myocardial longitudinal strain in injected segmentes as opposed to noninjected segments (2.4±8.3 vs. -0.9±6.1; P=0.05). We also established a correlation between improvement in myocardial strain and clinical response to cell therapy: responders demonstrated a significant improvement in longitudinal strain in injected segments, but non-responders did not (6.29±8.1 vs. -3.4±5.1; P=0.007). No difference was seen between responders and nonresponders with regards to myocardial strain of noninjected segments (2.4±8.4 vs. -0.97±6.1; P=0.59).
Conclusions:
Intramyocardial CD 34+ cell transplantation appears to improve left ventricular segmental wall motion in patients with ischemic cardiomyopathy.
Prognostic Impact of Segmental Wall Motion Abnormality in Patients With Idiopathic Dilated Cardiomyopathy
