Abstract 15652: Cell Therapy in Heart Failure With Preserved Ejection Fraction (CELLpEF)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bojan VRTOVEC ◽  
Sabina Frljak ◽  
Gregor Poglajen ◽  
Gregor Zemljic ◽  
Andraz Cerar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cell Therapy ◽  
Phase 1 ◽  
Preserved Ejection Fraction ◽  
Walk Test ◽  
Phase 2 ◽  
Systolic Strain ◽  
Test Distance ◽  
6 Minute Walk Test ◽  
Minute Walk

Introduction: Previous studies have demonstrated that cell therapy may improve diastolic parameters in heart failure. Hypothesis: We sought to investigate the effects of transendocardial CD34 + cell therapy in patients with heart failure with preserved ejection fraction (HFpEF). Methods: In a prospective crossover study, we enrolled 30 patients with HFpEF (LVEF>50%, E/e'>15, NT-proBNP >300 pg/ml). In Phase 1, patients were treated with stable medical therapy for 6 months. Thereafter, all patients underwent transendocardial CD34 + cell transplantation. They received bone marrow stimulation with filgrastim (10 mcg/kg, 5 days); CD34 + cells were collected by apheresis. We performed electroanatomical mapping of the left ventricle, and injected the cells transendocardialy in the areas of local diastolic dysfunction (80 million CD34 + cells divided into 20 injections). Patients were followed for 6 months after the procedure (Phase 2). Results: Our cohort included 23 male and 7 female patients aged 62±10 years, with LVEF of 58.7±7.3%, creatinine of 93±35 μmol/L, and bilirubin of 14.3±6.8 μmol/L. In Phase 1 (medical therapy), we found no change in E/e' (from 18.0±3.5 to 17.4±3.0, P=0.97), global systolic strain (from -12.5±2.4% to -12.8±2.6%, P=0.77), NT-proBNP levels (from 1463±1247 pg/mL to 1298±931 pg/mL, P=0.31), or 6-minute walk test distance (from 391±75 m to 402±93 m, P=0.42). In contrast, in Phase 2 (cell therapy), we found a significant improvement in E/e' (from 17.4±3.0 to 11.9±2.6, P=<0.0001), a decrease in NT-proBNP levels (from 1298±931 pg/ml to 887±809 pg/ml, P=0.02), and an improvement in 6-minute walk test distance (from 402±93 m to 438±72 m, P=0.02). Although global systolic strain did not change significantly in Phase 2 (from -12.8±2.6% to -13.8±2.7%, P=0.36), we found a significant improvement of local systolic strain in myocardial segments that were injected with stem cells (-3.4±6.8%, P=0.005). Conclusion: In patients with HFpEF, transendocardial CD34 + cell therapy appears to be associated with improved left ventricular diastolic parameters, better exercise capacity, a decrease in NT-proBNP levels, and improved local systolic strain at cell injection sites.

scholarly journals Effect of nitrate treatment on functional capacity and exercise time in patients with heart failure: a systematic review and meta-analysis

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093974
Author(s):  
Wenjie Long ◽  
Huili Liao ◽  
Qingqing Liu ◽  
Yile Ning ◽  
Tingchun Wu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Walk Test ◽  
Exercise Time ◽  
Nitrate Treatment ◽  
All Cause Mortality ◽  
Test Distance ◽  
6 Minute Walk Test ◽  
Minute Walk

Objectives Heart failure (HF) is a common and potentially fatal condition. In 2015, HF affected approximately 40 million people globally. Evidence showing that the use of nitrates can improve clinical outcomes in patients with HF is limited. This study aimed to assess the effect of nitrates on functional capacity and exercise time in patients with HF. Methods PubMed, Cochrane Library, and Embase databases were reviewed for articles on the use of nitrates and other treatments for patients with HF. The primary endpoints were the 6-minute walk test distance, exercise time, and quality of life. Secondary endpoints were all-cause mortality, arrhythmia, hospitalization, and worsening HF. The weighted mean difference, risk ratio, and 95% confidence interval were calculated. Results A total of 14 related studies that comprised 26,321 patients were included. No significant differences were found in the 6-minute walk test distance, exercise time, and quality of life between the nitrate and control treatment groups. There were also no differences in all-cause mortality, the incidence of arrhythmia, hospitalization, and worsening HF between these two groups. Conclusion Patients with HF who receive nitrate treatment do not have better quality of life or exercise capacity compared with controls.

scholarly journals Moderate intensity exercise training in heart failure with preserved ejection fraction: functional and structural benefits (The MIET-HFpEF trial)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A El Amrawy ◽  
M Hassanein ◽  
S Ayad ◽  
F Eldabe
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Care ◽  
Diastolic Function ◽  
Functional Capacity ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Walk Test ◽  
6 Minute Walk Test ◽  
Minute Walk

Abstract Background Heart failure with preserved ejection fraction (HFpEF) represents more than one half of the heart failure cases worldwide with increased morbidity and mortality. No proven medical treatment till now have shown mortality benefit in HFpEF. This study aims to elucidate the benefits of cardiac rehabilitation (CR) in HFpEF. Methods Sixty patients with HFpEF were included in 2 groups with 1:1 randomization.Group1 received usual medical care plus 2–3 rehabilitation sessions per week using moderate exercise with 40–75% of heart rate reserve on treadmill (up to 60 minutes according to the functional capacity). Group 2 received only usual medical care. Comparison between the 2 groups recording the percentage of improvement in echocardiographic diastolic function parameters, Minnesota living with heart failure questionnaire (MLWHFQ) and 6 -minute walk test at baseline and after 12 weeks. Results Group 1 showed significant improvement in the following: a. MLWHFQ (total score mean percentage of reduction) 305.60±158.44 versus (vs) 69.44±17.71 (p&lt;0.001).b. E/e' mean percentage of reduction 65.96±34.55 vs 18.23±13.98 (p&lt;0.001). c. Left atrial (LA) volume index mean percentage of reduction 27.86±13.27 vs 8.03±4.40 (p&lt;0.001). d. Pulmonary artery systolic pressure mean percentage of reduction was 33.85±14.68 vs 22.97±16.54 (p=0.02). e. 6–minute walk test 111.79±40.97 vs 46.33±11.58 (p&lt;0.001). f. Body mass index percentage of reduction 10.17±3.64 vs 2.80±1.60 (p&lt;0.001). g. Percentage of patients with down-grading of the degree of diastolic dysfunction: 10 patients (33.3%) vs 3 patients (10%) (P=0.028). h. However, there were no significant differences in left ventricular ejection fraction or other parameters as E/A ratio, LA dimension, isovolumetric relaxation time, degree of left ventricular hypertrophy. Conclusion CR not only added significant functional improvement in the quality of life and functional capacity in patients with HFpEF but also a significant structural improvement by improving the core items of diastolic function. In the light of the results of this study, we can recommend CR as a part of HFpEF management. FUNDunding Acknowledgement Type of funding sources: None.

Direct Myocardial Implantation of Human Fetal Stem Cells in Heart Failure Patients: Long-term Results

2010 ◽  
Vol 13 (1) ◽  
pp. 31 ◽  
Author(s):  
Federico Benetti ◽  
Ernesto Pe�herrera ◽  
Teodoro Maldonado ◽  
Yan Duarte Vera ◽  
Valvanur Subramanian ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stem Cells ◽  
Cardiac Function ◽  
Nyha Class ◽  
Left Ventricular ◽  
Long Term Results ◽  
Walk Test ◽  
The Mean ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: End-stage heart failure (HF) is refractory to current standard medical therapy, and the number of donor hearts is insufficient to meet the demand for transplantation. Recent studies suggest autologous stem cell therapy may regenerate cardiomyocytes, stimulate neovascularization, and improve cardiac function and clinical status. Although human fetal-derived stem cells (HFDSCs) have been studied for the treatment of a variety of conditions, no clinical studies have been reported to date on their use in treating HF. We sought to determine the efficacy and safety of HFDSC treatment in HF patients.Methods and Results: Direct myocardial transplantation of HFDSCs by open-chest surgical procedure was performed in 10 patients with HF due to nonischemic, nonchagasic dilated cardiomyopathy. Before and after the procedure, and with no changes in their preoperative doses of medications (digoxin, furosemide, spironolactone, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, betablockers), patients were assessed for New York Heart Association (NYHA) class, performance in the exercise tolerance test (ETT), ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) via transthoracic echocardiography, performance in the 6-minute walk test, and performance in the Minnesota congestive HF test. All 10 patients survived the operation. One patient had a stroke 3 days after the procedure, and although she later recovered, she was unable to perform the follow-up tests. Another male patient experienced pericardial effusion 3 weeks after the procedure. Although it resolved spontaneously, the patient abandoned his control tests and died 5 months after the procedure. An autopsy of the myocardium suggested that new young cells were present in the cardiomyocyte mix. At 40 months, the mean (SD) NYHA class decreased from 3.4 0.5 to 1.33 0.5 (P = .001); the mean EF increased 31%, from 26.6% 4% to 34.8% 7.2% (P = .005); and the mean ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% increase in metabolic equivalents, from 2.46 to 5.63) (P < .0001); the mean LVEDD decreased 15%, from 6.85 0.6 cm to 5.80 0.58 cm (P < .001); mean performance in the 6-minute walk test increased by 43.2%, from 251 113.1 seconds to 360 0 seconds (P = .01); the mean distance increased 64.4%, from 284.4 144.9 m to 468.2 89.8 m (P = .004); and the mean result in the Minnesota test decreased from 71 27.3 to 6 5.9 (P < .001).Conclusion: Although these initial findings suggest direct myocardial implantation of HFDSCs is feasible and improves cardiac function in HF patients at 40 months, more clinical research is required to confirm these observations.

scholarly journals Long-Term Re-Admission after Hospital Discharge in Patients Admitted with Acute Heart Failure: The Prognostic Value of the Six-Minute Walk Test Distance

OALib ◽  
2018 ◽  
Vol 05 (09) ◽  
pp. 1-11
Author(s):  
Dakaboué Germain Mandi ◽  
Dangwé Temoua Na？bé ◽  
Joel Bamouni ◽  
Rélwendé Aristide Yaméogo ◽  
Yibar Kambiré ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Discharge ◽  
Acute Heart Failure ◽  
Prognostic Value ◽  
Walk Test ◽  
Six Minute Walk Test ◽  
Test Distance ◽  
Minute Walk
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