Abstract 15258: Higer Unipolar Voltage at Cell Injection Sites Correlates With Better Outcomes After Transendocardial Cd34 + Cell Transplantation in Patients With Chronic Heart Failure
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Medientyp:
E-Artikel
Titel:
Abstract 15258: Higer Unipolar Voltage at Cell Injection Sites Correlates With Better Outcomes After Transendocardial Cd34 + Cell Transplantation in Patients With Chronic Heart Failure
Beschreibung:
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<jats:bold>Introduction:</jats:bold>
The evidence supporting the impact of electroanatomic guidance in defining the targets for transendocardial cell injections in chronic heart failure (CHF) remains inconclusive.
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<jats:bold>Hypothesis:</jats:bold>
We evaluated a correlation between electroanatomic properties of the myocardium at the cell injection sites and clinical response to CD34
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cell therapy in CHF patients.
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<jats:bold>Methods:</jats:bold>
We enrolled 131 consecutive patients with CHF and LVEF<40% undergoing CD34
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cell therapy at a single study site. All patients received bone-marrow stimulation with filgrastim for 5 days; CD34
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cells were collected by apheresis and injected transendocardialy (80x10
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cells per patient). Target injection sites were defined by electroanatomical mapping as myocardial areas with unipolar voltage >8.3mV and local linear shortening <6%. Favorable clinical response was defined as an increase in LVEF≥5% between baseline and 6 months follow-up.
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<jats:bold>Results:</jats:bold>
Of 131 patients 69 (53%) displayed a favorable clinical response (Group A) and 62 (47%) patients failed to respond to cell therapy (Group B). At baseline, the groups did not differ in gender (male: 89% in Group A vs. 84% in Group B, P=0.45), age (53±12 years vs. 55±11 years, P=0.25), CHF etiology (ischemic: 22% vs. 32%, P=0.17), LVEF (29±6% vs. 32±7%, P=0.06), or LVEDD (6.3±1.2 cm vs. 6.7±1.0 cm, P=0.10). Patients in Group A had lower baseline creatinine (81±20 μmol/L vs. 92±24 μmol/L in Group B, P=0.005), and lower levels of NT-proBNP (931±1078 pg/mL vs. 2716±2716, P=0.001). The number of cell injections in Groups A and B was comparable (17.3±2.6 injections vs. 17.6±3.5 injections, P=0.60). When analyzing the electroanatomical properties at cell injection sites, we found significantly higher unipolar voltage in Group A (11.2±3.7 mV vs. 9.5±2.6 mV in Group B, P=0.005). However, we found no differences in injection site local linear shortening between the groups (2.7±3.9% in Group A vs. 3.4±3.4 in group B, P=0.56).
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<jats:bold>Conclusions:</jats:bold>
In CHF patients, higher unipolar voltage at the cell injection sites appears to correlate with better clinical response to transendocardial CD34
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cell therapy. Thus, cell injections guided by measurements of myocardial viability may offer an advantage over blind cell injection strategies in this patient population.
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