title: Comparison of transendocardial and intracoronary CD34+ cell transplantation in patients with nonischemic dilated cardiomyopathy.
abstract: BACKGROUND
  In an open-label blinded study, we compared intracoronary and transendocardial CD34(+) cell transplantation in patients with nonischemic dilated cardiomyopathy.
  
  
  RESULTS
  Of the 40 patients with dilated cardiomyopathy, 20 were randomized to receive intracoronary injection and 20 received transendocardial CD34(+) cell delivery. In both groups, CD34(+) cells were mobilized by filgrastim, collected via apheresis, and labeled with technetium-99m radioisotope for single-photon emission computed tomographic imaging. In the intracoronary group, cells were injected intracoronarily in the artery supplying segments of greater perfusion defect on myocardial perfusion scintigraphy. In the transendocardial group, electroanatomic mapping was used to identify viable but dysfunctional myocardium, and transendocardial cell injections were performed. Nuclear single-photon emission computed tomographic imaging for quantification of myocardial retention was performed 18 hours thereafter. At baseline, groups did not differ in age, sex, left ventricular ejection fraction, or N-terminal pro-brain natriuretic peptide levels. The number of CD34(+) cells was also comparable (105 ± 31 × 10(6) in the transendocardial group versus 103 ± 27 × 10(6) in the intracoronary group, P=0.62). At 18 hours after procedure, myocardial retention was higher in the transendocardial group (19.2 ± 4.8%) than in the intracoronary group (4.4 ± 1.2%, P<0.01). At 6 months, left ventricular ejection fraction improved more in the transendocardial group (+8.1 ± 4.3%) than in the intracoronary group (+4.2 ± 2.3%, P=0.03). The same pattern was observed for the 6-minute walk test distance (+125 ± 33 m in the transendocardial group versus +86 ± 13 m in the intracoronary group, P=0.03) and N-terminal pro-brain natriuretic peptide (-628 ± 211 versus -315 ± 133 pg/mL, P=0.04).
  
  
  CONCLUSIONS
  In patients with dilated cardiomyopathy, transendocardial CD34(+) cell transplantation is associated with higher myocardial retention rates and greater improvement in ventricular function, N-terminal pro-brain natriuretic peptide, and exercise capacity compared with intracoronary route.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01350310.
authors.affiliation: Advanced Heart Failure and Transplantation Center (B.V., G.P.), Department of Nuclear Medicine (L.L., A.S.), and Department of Hematology (M.S., P.C.), University Medical Center Ljubljana, Ljubljana, Slovenia; National Blood Transfusion Institute, Ljubljana, Slovenia (D.D.); Methodist DeBakey Heart Center, Houston, TX (G.T.-A.); Stanford Cardiovascular Institute (F.H., J.C.W.) and Department of Medicine, Division of Cardiology (B.V., F.H., J.C.W.), Stanford University School of Medicine, Stanford, CA.
authors.forename: Bojan
authors.initials: B
authors.lastname: Vrtovec
authors.forename: Gregor
authors.initials: G
authors.lastname: Poglajen
authors.forename: Luka
authors.initials: L
authors.lastname: Lezaic
authors.forename: Matjaz
authors.initials: M
authors.lastname: Sever
authors.forename: Aljaz
authors.initials: A
authors.lastname: Socan
authors.forename: Dragoslav
authors.initials: D
authors.lastname: Domanovic
authors.forename: Peter
authors.initials: P
authors.lastname: Cernelc
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.forename: François
authors.initials: F
authors.lastname: Haddad
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Wu
mesh_terms: D000368:Aged; D018952:Antigens, CD34 / Q000008:administration & dosage / Q000096:biosynthesis*; D016026:Bone Marrow Transplantation / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D004699:Endocardium / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D033581:Stem Cell Transplantation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34
keywords: cardiomyopathy, dilated; heart failure; stem cells