İskemik ve İskemik Olmayan Dilate Kardiyomiyopatide Mezenkimal Kök Hücre Etkinliğinin Karşılaştırılması.

Soyut
BACKGROUND:
İskemik kardiyomiyopati (ICM) ve dilate kardiyomiyopati (DCM) histopatoloji ve prognoz açısından farklılık gösterir. Mezenkimal kök hücrelerin transendokardiyal iletimi güvenli olmasına ve her iki durumda da kardiyovasküler faydalar sağlamasına rağmen, 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, rastgele, 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); Ve (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). Benzer şekilde, 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<0.0001) versus 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) hastalar.

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.