Department of Cardiology.
Advanced Heart Failure and Transplantation Center, UMC Ljubljana, Slovenia.
Stem Cells Transl Med. 2017 Jun;6(6):1515-1521. doi: 10.1002/sctm.16-0331. Epub 2017 Mar 11.
We sought to evaluate the physiological background and the effects of CD34 cell transplantation on diastolic parameters in nonischemic dilated cardiomyopathy patients (DCM). We enrolled 38 DCM patients with NYHA class III and LVEF < 40% who underwent transendocardial CD34 cell transplantation. Peripheral blood CD34 cells were mobilized by G-CSF, collected via apheresis, and injected transendocardially in the areas of myocardial hibernation. Patients were followed for 1 year. At baseline, estimated filling pressures were significantly elevated (E/e' ≥ 15) in 18 patients (Group A), and moderately elevated (E/e '< 15) in 20 patients (Group B). The groups did not differ in age (54 ± 9 years vs. 52 ± 10 years; p = .62), gender (male: 85% vs. 78%; p = .57), or LVEF (31 ± 7% vs. 34 ± 6%; p = .37). When compared to Group B patients in Group A had more segments with myocardial scar (4.9 ± 2.7 vs. 2.7 ± 2.9; p = .03), myocardial hibernation (2.2 ± 1.6 vs. 0.9 ± 1.1; p = .02), and longer average local relaxation time on electroanatomical mapping (378 ± 41 ms vs. 333 ± 34 ms, p = .01). During follow-up there was an improvement in diastolic parameters in Group A (E/e': from 24.3 ± 12.1 to 16.3 ± 8.0; p = .005), but not in Group B (E/e': from 10.2 ± 3.7 to 13.2 ± 9.1; p = .19). Accordingly, in Group A, we found an increase in 6-minute walk distance (from 463 ± 83 m to 546 ± 91 m; p = .03), and a decrease in NT-proBNP (from 2140 ± 1743 pg/ml to 863 ± 836 pg/ml; p = .02). In nonischemic DCM, diastolic dysfunction appears to correlate with areas of myocardial scar and hibernation. Transendocardial CD34 cell transplantation may improve diastolic parameters in this patient cohort. Stem Cells Translational Medicine 2017;6:1515-1521.
我们旨在评估非缺血性扩张型心肌病（DCM）患者 CD34 细胞移植对舒张参数的生理背景和影响。我们纳入了 38 例纽约心脏病协会（NYHA）心功能分级 III 级和左心室射血分数（LVEF）<40%的 DCM 患者，这些患者接受了经心内膜 CD34 细胞移植。通过 G-CSF 动员外周血 CD34 细胞，通过单采术收集，并在心内膜冬眠心肌区域注射。患者随访 1 年。在基线时，18 例患者（A 组）的估计充盈压显著升高（E/e'≥15），20 例患者（B 组）的估计充盈压中度升高（E/e'<15）。两组在年龄（54±9 岁 vs. 52±10 岁；p=0.62）、性别（男性：85% vs. 78%；p=0.57）或 LVEF（31±7% vs. 34±6%；p=0.37）方面无差异。与 B 组相比，A 组的心肌瘢痕（4.9±2.7 个 vs. 2.7±2.9 个；p=0.03）、冬眠心肌（2.2±1.6 个 vs. 0.9±1.1 个；p=0.02）和心内膜电描记图上的平均局部弛豫时间（378±41 ms vs. 333±34 ms，p=0.01）更长。在随访期间，A 组的舒张参数有所改善（E/e'：从 24.3±12.1 降至 16.3±8.0；p=0.005），但 B 组无改善（E/e'：从 10.2±3.7 增至 13.2±9.1；p=0.19）。相应地，在 A 组中，我们发现 6 分钟步行距离增加（从 463±83 m 增加至 546±91 m；p=0.03），NT-proBNP 减少（从 2140±1743 pg/ml 减少至 863±836 pg/ml；p=0.02）。在非缺血性 DCM 中，舒张功能障碍似乎与心肌瘢痕和冬眠区相关。经心内膜 CD34 细胞移植可能改善该患者队列的舒张参数。《干细胞转化医学》2017；6:1515-1521.
