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

Figures

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  Figure 1. Flow chart of the study design. At baseline, we analyzed parameters of diastolic function in all patients and classified them in two groups according to the presence of diastolic dysfunction, defined by elevated estimated filling pressures (E/e′ ≥ 15). In all patients, peripheral blood CD34+ cells were mobilized by G‐CSF, collected via apheresis, and injected transendocardially in the areas of electromechanical mismatch on electro‐anatomical mapping. Patients were followed for 1 year.

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  Figure 2. Analysis of local diastolic function. Exemplary postprocessing analysis of local diastolic function by measuring radial deformation (relative to heart axis) of each mapping point in 10 ms intervals. The 3D color‐coded map displays the timing of diastole (red areas represent early diastole, purple areas represent late diastole).

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  Figure 3. Analysis of scar and hibernation. Exemplary 3D (A, C) and corresponding 2D (B, D) quantitative polar maps of a patient with nonischemic DCM, showing unipolar voltage and linear shortening. Segments with predominance of high unipolar voltage and high LLS (purple, blue, or green color on both panels) are defined as normal myocardium (N); segments with predominance of low unipolar voltage and low LLS (red and yellow color on both panels) are defined as scarred myocardium (S); and segments with a predominance of high unipolar voltage (purple, blue, or green on left panel) and low LLS (red or yellow on right panel) are defined as hibernating myocardium (H). Abbreviation: LLS, linear shortening.

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  Figure 4. The effects of CD34+ cell therapy on estimated left ventricular filling pressures in patients with nonischemic DCM. Within 1 year, we have found a significant improvement in estimated left ventricular filling pressures (measured by E/e′) only in patients who displayed elevated filling pressures at baseline (E/e′ ≥ 15). In the remaining cohort, no significant change in E/e' was found.

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  Figure 5. Differences in local diastolic function in patients in with higher (Group A) and lower (Group B) E/e'. The average local relaxation time measured by electro‐anatomical mapping was significantly higher in patients with higher E/e'. This difference was even more pronounced when analyzing local relaxation time at the sites of cell injections.