Abstract 13605: Predictors of Long-Term Outcome Following Transendocardial Cd34+Cell Transplantation in Chronic Heart Failure Patients

Introduction:The results of cell therapy in chronic heart failure (CHF) patients have been inconsistent, possibly also due to poorly defined patient selection criteria.Hypothesis:To better define good responders to cell therapy we sought to evaluate the predictors of long-term outcome of transendocardial CD34+cell therapy in CHF patient population.Methods:Pooled data from 108 patients included in a single center registry were analyzed for baseline clinical, laboratory and echocardiographic parameters. All patients received granulocyte-colony stimulating factor for 5 days; CD34+cells were collected by apheresis and injected transendocardially guided by electroanatomical mapping. Target sites for cell injections were defined as areas with unipolar voltage >8.3 mV and linear local shortening <6%. Patients were followed for 5 years after the procedure.Results:Of 108 patients 93 (87%) were alive (Group A) and 15 (13%) were dead (Group B) at 5 years. 12 (80%) patients died due to pump failure and 3 (20%) due to sudden cardiac death. At baseline the two groups did not differ in age (52?10 years in Group A vs. 57?8 years in Group B, P=0.12), gender (male: 80% vs. 100%, P=0.07), CHF etiology (ischemic: 43% vs. 40%, P=0.85), liver dysfunction (34% vs. 37%, P=0.12), glucose (6.1?1.8 mmol/L vs. 5.8?1.2 mmol/L, P=0.53), hemoglobin (14.5?1 mg/dl vs. 14.1?1.3 mg/dL, P=0.37) or the presence of ICD therapy (40% vs. 27%, P=0.31). However, we found significant differences in baseline left ventricular ejection fraction (LVEF: 29?7% in Group A vs. 24?6% in Group B, P<0.05), left ventricular end-diastolic diameter (LVEDD: 6.6?0.7 cm vs. 7.1?0.7 cm, P<0.05), renal dysfunction (24% vs. 53%, P<0.05) and red cell distribution width (RDW: 14.1?1.2% vs. 15.1?1.4%, P<0.05). On multivariate analysis LVEF >30% and RDW less than 14.2% were identified as the independent predictors of favorable 5-year outcome after CD34+ cell therapy.Conclusions:Transendocardial CD34+cell therapy appears to be associated with favorable long-term outcome in patients with CHF. The beneficial effects may be particularly pronounced in patients with less severe left ventricular systolic dysfunction and lower degree of CHF-related bone marrow suppression.