Advanced Heart Failure and Transplantation Center, UMC Ljubljana, Slovenia.
Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.
Mayo Clin Proc. 2020 Oct;95(10):2125-2133. doi: 10.1016/j.mayocp.2020.02.031.
To investigate the association of left ventricular end-diastolic volume (LVEDV) and the response to cell therapy in patients with nonischemic dilated cardiomyopathy (NICM).
Five-year registry data from 133 consecutive patients with NICM who underwent CD34 cell treatment were analyzed. All patients received granulocyte-colony stimulating factor; CD34 cells were collected by apheresis and delivered by transendocardial injections. Patients with baseline LVEDV less than 200 mL (group A; n=72) and patients with LVEDV 200 to 370 mL (group B; n=54) were included. Patients with LVEDV greater than 370 mL were excluded (n=7). Favorable ejection fraction response was pre-defined by improvement in left ventricular ejection fraction (LVEF) greater than or equal to 5% at 1 y post-cell therapy.
At baseline, groups A and B were comparable with regards to age (52±11 y in group A vs 53±10 y in group B; P=.95), sex (male: 79% vs 83%, respectively; P=.55), creatinine (1.07±0.28 mg/dL vs 1.03±0.21 mg/dL, respectively; P=.21), or N-terminal probrain natriuretic peptide (1454±1658 pg/mL vs 1589±1338 pg/mL, respectively; P=.80). Baseline LVEF was higher in group A (32.8±8.7%) than in group B (30.2±8.7%; P=.03). During follow-up, there were four deaths in group A (5.6%), and 2 in group B (3.7%, P=.63). At 1-year post-cell therapy, LVEDV decreased significantly in group B (-56±30 mL; P=.003), but not in group A (+12±97 mL; P=.13). On multivariate analysis, baseline LVEDV was an independent correlate of favorable response in LVEF to therapy (P=.02).
Larger LVEDV was associated with more pronounced increase in LVEF after transendocardial CD34 cell therapy in NICM patients, informing target individuals with the highest likelihood of regenerative response.
clinicaltrials.gov identifier: NCT02445534.
探讨左心室舒张末期容积（LVEDV）与非缺血性扩张型心肌病（NICM）患者细胞治疗反应的关系。
对 133 例连续接受 CD34 细胞治疗的 NICM 患者的 5 年登记数据进行分析。所有患者均接受粒细胞集落刺激因子治疗；CD34 细胞通过体外分离术采集，并通过心内膜内注射给药。将基线 LVEDV 小于 200mL 的患者纳入 A 组（n=72），LVEDV 为 200-370mL 的患者纳入 B 组（n=54），LVEDV 大于 370mL 的患者排除在外（n=7）。将左心室射血分数（LVEF）增加大于等于 5%定义为细胞治疗后 1 年时射血分数的有利反应。
基线时，A 组和 B 组在年龄（A 组 52±11 岁，B 组 53±10 岁；P=.95）、性别（男性：分别为 79%和 83%；P=.55）、肌酐（1.07±0.28mg/dL 与 1.03±0.21mg/dL；P=.21）或 N 末端脑利钠肽前体（1454±1658pg/mL 与 1589±1338pg/mL；P=.80）方面无差异。A 组的基线 LVEF 高于 B 组（32.8±8.7%与 30.2±8.7%；P=.03）。随访期间，A 组有 4 例死亡（5.6%），B 组有 2 例（3.7%；P=.63）。细胞治疗后 1 年，B 组的 LVEDV 明显降低（-56±30mL；P=.003），但 A 组无明显变化（+12±97mL；P=.13）。多变量分析显示，基线 LVEDV 是治疗后 LVEF 反应良好的独立相关因素（P=.02）。
在 NICM 患者中，心内膜内 CD34 细胞治疗后，较大的 LVEDV 与 LVEF 更明显的增加相关，提示具有最高再生反应可能性的目标个体。
clinicaltrials.gov 标识符：NCT02445534。
