Advanced Heart Failure and Transplantation Center, Department of Cardiology, Ljubljana University Medical Center, Zaloska 7, Ljubljana, MC SI-1000, Slovenia.
Circ Res. 2013 Jan 4;112(1):165-73. doi: 10.1161/CIRCRESAHA.112.276519. Epub 2012 Oct 12.
CD34+ transplantation in dilated cardiomyopathy was associated with short-term improvement in left ventricular ejection fraction and exercise tolerance.
We investigated long-term effects of intracoronary CD34+ cell transplantation in dilated cardiomyopathy and the relationship between intramyocardial cell homing and clinical response.
Of 110 dilated cardiomyopathy patients, 55 were randomized to receive CD34+ stem cell transplantation (SC group) and 55 received no cell therapy (controls). In the SC group, CD34+ cells were mobilized by granulocyte colony-stimulating factor and collected via apheresis. Patients underwent myocardial scintigraphy and cells were injected in the artery supplying segments with the greatest perfusion defect. At baseline, 2 groups did not differ in age, sex, left ventricular ejection fraction, or N-terminal B-type natriuretic peptide levels. At 5 years, stem cell therapy was associated with increased left ventricular ejection fraction (from 24.3 ± 6.5% to 30.0 ± 5.1%; P=0.02), increased 6-minute walk distance (from 344 ± 90 m to 477 ± 130 m; P<0.001), and decreased N-terminal B-type natriuretic peptide (from 2322 ± 1234 pg/mL to 1011 ± 893 pg/mL; P<0.01). Left ventricular ejection fraction improvement was more significant in patients with higher myocardial homing of injected cells. During follow-up, 27 (25%) patients died and 9 (8%) underwent heart transplantation. Of the 27 deaths, 13 were attributed to pump failure and 14 were attributed to sudden cardiac death. Total mortality was lower in the SC group (14%) than in controls (35%; P=0.01). The same was true of pump failure (5% vs. 18%; P=0.03), but not of sudden cardiac death (9% vs. 16%; P=0.39).
Intracoronary stem cell transplantation may be associated with improved ventricular function, exercise tolerance, and long-term survival in patients with dilated cardiomyopathy. Higher intramyocardial homing is associated with better stem cell therapy response.
CD34+ 移植治疗扩张型心肌病可短期改善左心室射血分数和运动耐量。
我们研究了经冠状动脉 CD34+ 细胞移植治疗扩张型心肌病的长期疗效，以及细胞归巢与临床反应的关系。
110 例扩张型心肌病患者中，55 例随机分为 CD34+ 干细胞移植组（SC 组），55 例未接受细胞治疗（对照组）。SC 组患者采用粒细胞集落刺激因子动员外周血干细胞，通过血细胞分离机采集 CD34+细胞。所有患者均接受心肌闪烁显像检查，并将细胞注射到灌注缺损最大的供血节段动脉内。基线时，两组患者的年龄、性别、左心室射血分数或 N 末端 B 型利钠肽水平无差异。5 年后，干细胞治疗组左心室射血分数增加（从 24.3%±6.5%增加至 30.0%±5.1%；P=0.02），6 分钟步行距离增加（从 344±90 m 增加至 477±130 m；P<0.001），N 末端 B 型利钠肽降低（从 2322±1234 pg/ml 降低至 1011±893 pg/ml；P<0.01）。注射细胞的心肌归巢率较高的患者左心室射血分数改善更显著。随访期间，27 例（25%）患者死亡，9 例（8%）患者接受心脏移植。27 例死亡患者中，13 例归因于泵衰竭，14 例归因于心脏性猝死。SC 组总死亡率（14%）低于对照组（35%；P=0.01）。泵衰竭发生率（5% vs. 18%；P=0.03）也低于对照组，但心脏性猝死发生率（9% vs. 16%；P=0.39）无差异。
经冠状动脉干细胞移植可能改善扩张型心肌病患者的心室功能、运动耐量和长期生存率。心肌内归巢率较高与更好的干细胞治疗反应相关。
