Effects of Intracoronary Cd34+ Stem Cell Transplantation in Non-Ischemic Dilated Cardiomyopathy Patients: 5-Year Follow Up
Rationale: CD34+ transplantation in dilated cardiomyopathy (DCM) was associated with short-term improvement in LVEF and exercise tolerance.
Objective: We investigated long-term effects of intracoronary CD34+ cell transplantation in DCM and the relationship between intramyocardial cell homing and clinical response.
Methods and Results: Of 110 DCM patients, 55 were randomized to receive CD34+ cell transplantation (SC group), and 55 received no cell therapy (controls). In SC group, CD34+ cells were mobilized by G-CSF 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, gender, LVEF, or NT-proBNP levels. At 5 years, stem cell therapy was associated with increased LVEF (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 NT-proBNP (from 2322±1234 pg/mL to 1011±893 pg/mL; P<0.01). LVEF 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 to sudden cardiac death. Total mortality was lower in SC group (14%) than 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).
Conclusions: Intracoronary stem cell transplantation may be associated with improved ventricular function, exercise tolerance, and long-term survival in patients with DCM. Higher intramyocardial homing is associated with better stem cell therapy response.
- Received June 27, 2012.
- Accepted October 12, 2012.
- Copyright © 2012, American Heart Association