Comparison of Mesenchymal Stem Cell Efficacy in Ischemic Versus Nonischemic Dilated Cardiomyopathy

Autor: Gianna M. Rodriguez, Victoria Florea, Angela C. Rieger, Makoto Natsumeda, Monisha N. Banerjee, Joshua M. Hare, Ana Marie Landin, Evan Nigh, Konstantinos E. Hatzistergos, Ivonne Hernandez Schulman, Bryon A. Tompkins
Rok vydání: 2018
Předmět:
Adult
Cardiomyopathy
Dilated
Male
0301 basic medicine
medicine.medical_specialty
Pathology
Myocardial Infarction
Myocardial Ischemia
Dilative cardiomyopathy
030204 cardiovascular system & hematology
Mesenchymal Stem Cell Transplantation
Ventricular Dysfunction
Left
03 medical and health sciences
0302 clinical medicine
remodeling heart failure
functional capacity impairment
medicine
Humans
mesenchymal stem cell
Original Research
Aged
Randomized Controlled Trials as Topic
Heart Failure
Ischemic cardiomyopathy
Ventricular Remodeling
business.industry
Mesenchymal stem cell
Stroke Volume
Dilated cardiomyopathy
Middle Aged
medicine.disease
3. Good health
stem cell
030104 developmental biology
Quality of Life
Female
Histopathology
Stem cell
Cardiomyopathies
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.117.008460
Popis: Background Ischemic cardiomyopathy ( ICM ) and dilated cardiomyopathy ( DCM ) differ in histopathology and prognosis. Although transendocardial delivery of mesenchymal stem cells is safe and provides cardiovascular benefits in both, a comparison of mesenchymal stem cell efficacy in ICM versus DCM has not been done. Methods and Results We conducted a subanalysis of 3 single‐center, randomized, and blinded clinical trials: (1) TAC‐HFT (Transendocardial Autologous Mesenchymal Stem Cells and Mononuclear Bone Marrow Cells in Ischemic Heart Failure Trial); (2) POSEIDON (A Phase I/II, Randomized Pilot Study of the Comparative Safety and Efficacy of Transendocardial Injection of Autologous Mesenchymal Stem Cells Versus Allogeneic Mesenchymal Stem Cells in Patients With Chronic Ischemic Left Ventricular Dysfunction Secondary to Myocardial Infarction); and (3) POSEIDON‐DCM (Percutaneous Stem Cell Injection Delivery Effects on Neomyogenesis in Dilated Cardiomyopathy). Baseline and 1‐year cardiac structure and function and quality‐of‐life data were compared in a post hoc pooled analysis including ICM (n=46) and DCM (n=33) patients who received autologous or allogeneic mesenchymal stem cells. Ejection fraction improved in DCM by 7% (within‐group, P =0.002) compared to ICM (1.5%; within‐group, P =0.14; between‐group, P =0.003). Similarly, stroke volume increased in DCM by 10.59 mL ( P =0.046) versus ICM (−0.2 mL; P =0.73; between‐group, P =0.02). End‐diastolic volume improved only in ICM (10.6 mL; P =0.04) and end‐systolic volume improved only in DCM (17.8 mL; P =0.049). The sphericity index decreased only in ICM (−0.04; P =0.0002). End‐diastolic mass increased in ICM (23.1 g; P DCM (−4.1 g; P =0.34; between‐group, P =0.007). The 6‐minute walk test improved in DCM (31.1 m; P =0.009) and ICM (36.3 m; P =0.006) with no between‐group difference ( P =0.79). The New York Heart Association class improved in DCM ( P =0.005) and ICM ( P =0.02; between‐group P =0.20). The Minnesota Living with Heart Failure Questionnaire improved in DCM (−19.5; P =0.002) and ICM (−6.4; P =0.03; δ between‐group difference P =0.042) patients. Conclusions Mesenchymal stem cell therapy is beneficial in DCM and ICM patients, despite variable effects on cardiac phenotypic outcomes. Whereas cardiac function improved preferentially in DCM patients, ICM patients experienced reverse remodeling. Mesenchymal stem cell therapy enhanced quality of life and functional capacity in both etiologies. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifiers: TAC ‐ HFT : NCT 00768066, POSEIDON : NCT 01087996, POSEIDON ‐ DCM : NCT 01392625.
Databáze: OpenAIRE
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