Abstract 12200: Right Ventricular Dysfunction Correlates With Impaired Angiogenesis in Non-ischemic Dilated Cardiomyopathy Patients

Introduction:The underlying mechanisms of right ventricular (RV) dysfunction in non-ischemic dilated cardiomyopathy (NICM) remain poorly defined.Hypothesis:We investigated a correlation between alterations in angiogenesis and RV function in patients with NICM.Methods:We enrolled 40 NICM patients with NYHA class III and LVEF<40%. All patients received granulocyte-colony stimulating factor for 5 days; CD34+cells were collected by apheresis and injected transendocardially. At baseline and 6 months after cell therapy we measured plasma biomarkers of angiogenesis and assessed RV function by measuring tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity of tricuspid annulus (St), and fractional area change (FAC) using echocardiography. RV dysfunction was defined as TAPSE<17 mm, St< 9.5 cm/s and FAC< 35%. Improved RV function was defined as concomitant improvements in TAPSE, St and FAC.Results:At baseline, RV dysfunction was present in 25/40 patients (Group A), and 15/40 patients had preserved RV function (Group B). The groups did not differ in age (55?10 years in Group A vs. 57?6 years in Group B, P=0.72), gender (male: 84% vs. 78%, P=0.75), creatinine (0.94?0.33 mg/dL vs. 0.95?0.30 mg/dL, P=0.55), LVEF (32?8% vs. 31?7%, P=0.40), or NTproBNP levels (1870?1505 pg/mL vs. 1520?1225 pg/mL, P=0.72). When compared to Group B, patients in Group A displayed lower levels of pro-angiogenic biomarkers: vascular endothelial growth factor (VEGF): 30?20 pg/mL vs. 54?25 pg/mL, P=0.01; platelet-derived growth factor (PDGF): 53?23 pg/mL vs. 82?23 pg/mL, P=0.01, and higher levels of anti-angiogenic biomarkers: agiopoietin-2: 6.4?4.2 ng/mL vs. 2.3?0.7 ng/mL, P=0.01, endostatin: 86?29 ng/mL vs. 63?29 ng/mL, P=0.03. At 6 months, RV function improved in 26/40 patients. In this cohort, we found an increase in pro-angiogenic biomarkers (VEGF: +14?4 pg/mL, P=0.03; PDGF: +22?5 pg/mL, P=0.01), and a decrease of anti-angiogenic markers (angiopoietin-2: -3.1?1.0 ng/mL, P=0.01; endostatin: -26?9 ng/mL, P=0.02).Conclusion:In patients with NICM, RV dysfunction may be associated with impaired angiogenesis. In these patients, improvement of RV function after CD34+cell therapy appears to correlate with improved angiogenetic response.