Larger End-Diastolic Volume Associates With Response to Cell Therapy in Patients With Nonischemic Dilated Cardiomyopathy
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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
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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