title: Effects of Transendocardial CD34+Cell Transplantation on Diastolic Parameters in Patients with Nonischemic Dilated Cardiomyopathy.
abstract: We sought to evaluate the physiological background and the effects of CD34+cell transplantation on diastolic parameters in nonischemic dilated cardiomyopathy patients (DCM). We enrolled 38 DCM patients with NYHA class III and LVEF < 40% who underwent transendocardial CD34+cell transplantation. Peripheral blood CD34+cells were mobilized by G-CSF, collected via apheresis, and injected transendocardially in the areas of myocardial hibernation. Patients were followed for 1 year. At baseline, estimated filling pressures were significantly elevated (E/e' ≥ 15) in 18 patients (Group A), and moderately elevated (E/e '< 15) in 20 patients (Group B). The groups did not differ in age (54 ± 9 years vs. 52 ± 10 years; p = .62), gender (male: 85% vs. 78%; p = .57), or LVEF (31 ± 7% vs. 34 ± 6%; p = .37). When compared to Group B patients in Group A had more segments with myocardial scar (4.9 ± 2.7 vs. 2.7 ± 2.9; p = .03), myocardial hibernation (2.2 ± 1.6 vs. 0.9 ± 1.1; p = .02), and longer average local relaxation time on electroanatomical mapping (378 ± 41 ms vs. 333 ± 34 ms, p = .01). During follow-up there was an improvement in diastolic parameters in Group A (E/e': from 24.3 ± 12.1 to 16.3 ± 8.0; p = .005), but not in Group B (E/e': from 10.2 ± 3.7 to 13.2 ± 9.1; p = .19). Accordingly, in Group A, we found an increase in 6-minute walk distance (from 463 ± 83 m to 546 ± 91 m; p = .03), and a decrease in NT-proBNP (from 2140 ± 1743 pg/ml to 863 ± 836 pg/ml; p = .02). In nonischemic DCM, diastolic dysfunction appears to correlate with areas of myocardial scar and hibernation. Transendocardial CD34+cell transplantation may improve diastolic parameters in this patient cohort. Stem Cells Translational Medicine 2017;6:1515-1521.
authors.affiliation: Department of Cardiology.
authors.forename: Mojca
authors.initials: M
authors.lastname: Bervar
authors.affiliation: Department of Cardiology.
authors.forename: Mirta
authors.initials: M
authors.lastname: Kozelj
authors.affiliation: Advanced Heart Failure and Transplantation Center, UMC Ljubljana, Slovenia.
authors.forename: Gregor
authors.initials: G
authors.lastname: Poglajen
authors.affiliation: Department of Hematology, UMC Ljubljana, Slovenia.
authors.forename: Matjaz
authors.initials: M
authors.lastname: Sever
authors.affiliation: Advanced Heart Failure and Transplantation Center, UMC Ljubljana, Slovenia.
authors.forename: Gregor
authors.initials: G
authors.lastname: Zemljic
authors.affiliation: Advanced Heart Failure and Transplantation Center, UMC Ljubljana, Slovenia.
authors.forename: Sabina
authors.initials: S
authors.lastname: Frljak
authors.affiliation: National Blood Transfusion Institute, Ljubljana, Slovenia.
authors.forename: Marko
authors.initials: M
authors.lastname: Cukjati
authors.affiliation: Department of Hematology, UMC Ljubljana, Slovenia.
authors.forename: Peter
authors.initials: P
authors.lastname: Cernelc
authors.affiliation: Stanford University School of Medicine, Stanford, California, USA.
authors.forename: François
authors.initials: F
authors.lastname: Haddad
authors.affiliation: Advanced Heart Failure and Transplantation Center, UMC Ljubljana, Slovenia.|Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Bojan
authors.initials: B
authors.lastname: Vrtovec
mesh_terms: D000328:Adult; D018952:Antigens, CD34 / Q000187:drug effects / Q000235:genetics / Q000378:metabolism*; D002311:Cardiomyopathy, Dilated / Q000628:therapy*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D000072916:Peripheral Blood Stem Cells / Q000378:metabolism
chemical_list: D018952:Antigens, CD34; D016179:Granulocyte Colony-Stimulating Factor
keywords: Diastolic dysfunction cardiomyopathy; Heart failure; Stem cell