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Larger End-Diastolic Volume Associates With Response to Cell Therapy in Patients With Nonischemic Dilated
Sabina Frljak1, Gregor Poglajen1, Gregor Zemljic1
1Advanced Heart Failure and Transplantation Center, UMC Ljubljana, Slovenia.
Insights
Larger left ventricular end-diastolic volume (LVEDV) in nonischemic dilated cardiomyopathy (NICM) patients predicts a better response to CD34+ cell therapy. This finding helps identify patients most likely to benefit from regenerative treatments.
Area of Science:
- Cardiology
- Regenerative Medicine
- Stem Cell Therapy
Background:
- Nonischemic dilated cardiomyopathy (NICM) is a significant cause of heart failure.
- Cell therapy, specifically using CD34+ cells, is being investigated as a treatment for NICM.
- Predictors of treatment response in NICM patients undergoing cell therapy require further elucidation.
Purpose of the Study:
- To determine the association between left ventricular end-diastolic volume (LVEDV) and the efficacy of CD34+ cell therapy in NICM patients.
- To identify baseline LVEDV as a potential biomarker for predicting treatment response.
Main Methods:
- Analysis of 5-year registry data from 133 NICM patients treated with CD34+ cell therapy.
- Patients were categorized into two groups based on baseline LVEDV (<200 mL and 200-370 mL).
- Favorable response was defined as an improvement in left ventricular ejection fraction (LVEF) ≥5% at 1 year post-therapy.
Main Results:
- Baseline LVEDV was independently associated with a favorable LVEF response to therapy (P=.02).
- Patients with LVEDV 200-370 mL showed a significant decrease in LVEDV post-therapy (-56±30 mL; P=.003), unlike those with LVEDV <200 mL.
- No significant differences in mortality or baseline characteristics were observed between the groups.
Conclusions:
- Higher baseline LVEDV is associated with a greater increase in LVEF following transendocardial CD34+ cell therapy in NICM patients.
- Baseline LVEDV can inform the selection of patients most likely to achieve a regenerative response.
- This suggests LVEDV may serve as a predictive marker for cell therapy outcomes in NICM.
Objective:
To investigate the association of left ventricular end-diastolic volume (LVEDV) and the response to cell therapy in patients with nonischemic dilated cardiomyopathy (NICM).
Patients And Methods:
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.
Results:
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).
Conclusion:
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.
Trial Registration:
clinicaltrials.gov identifier: NCT02445534.
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