Effects of Transendocardial CD34+ Cell Transplantation on Diastolic Parameters in Patients with Nonischemic Dilated Cardiomyopathy

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 463683 m to 54 +/- 691 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.