Transcoronary transplantation of functionally competent BMCs is associated with a decrease in natriuretic peptide serum levels and improved survival of patients with chronic postinfarction heart failure -: Results of the TOPCARE-CHD registry
Transcoronary transplantation of functionally competent BMCs is associated with a decrease in natriuretic peptide serum levels and improved survival of patients with chronic postinfarction heart failure -: Results of the TOPCARE-CHD registry
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DOI：
10.1161/01.res.0000264508.47717.6b
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发表时间：
2007-04-27
影响因子：
20.1
通讯作者：
Zeiher, Andreas M.
中科院分区：
文献类型：
--
作者：
Assmus, Birgit;Fischer-Rasokat, Ulrich;Zeiher, Andreas M.
尽管冠状动脉内给药骨髓源性单核祖细胞（BMCs）可能与慢性梗死后心力衰竭患者心功能改善有关，但对这些患者的预后和临床结果的影响尚不清楚。为了确定有利临床结果的潜在预测因素，我们评估了钠肽血清水平作为心力衰竭和心源性死亡发生的客观标志物与121例连续接受冠状动脉内灌注bmc治疗的慢性缺血性心脏病患者的灌注细胞功能容量的关系。我们的分析表明，在经冠状动脉祖细胞给药3个月后，梗死后心力衰竭患者血清n端前脑钠肽（NT-proBNP）和n端前心房钠肽（NT-proANP）水平均显著降低。NT-proBNP血清水平大于或等于基线时的中位数（735 pg/mL）和大量具有集落形成能力的祖细胞是冠状动脉内给药3个月后良好反应的唯一独立预测因素。在延长的临床随访期间（577 +/- 442天），总患者人群中共发生14例死亡。全因死亡率和心脏死亡率的Kaplan-Meier曲线显示，接受集落形成细胞数量较多的患者死亡的可能性明显低于接受集落形成细胞数量较少的患者（P=0.01）。最重要的是，输注大量具有集落形成能力的细胞与基线NT-proBNP血清水平升高（>= 735 pg/mL；中位数）的患者的死亡率增加完全消除相关(P
Although intracoronary administration of bone marrow-derived mononuclear progenitor cells (BMCs) may be associated with improved cardiac function in patients with chronic postinfarction heart failure, the impact on prognosis and clinical outcome of these patients is unknown. To identify potential predictors for a favorable clinical outcome, we assessed natriuretic peptide serum levels as objective markers of heart failure and the occurrence of cardiac death in relation to functional capacity of the infused cells in a consecutive series of 121 patients with chronic ischemic heart disease treated with intracoronary infusion of BMCs. Our analyses show that both N-terminal pro-brain natriuretic peptide (NT-proBNP) and N-terminal pro-atrial natriuretic peptide (NT-proANP) serum levels were significantly reduced in patients with established postinfarction heart failure 3 months after transcoronary progenitor cell administration. NT-proBNP serum levels greater than or equal to median (735 pg/mL) at baseline and a high number of infused progenitor cells with colony-forming capacity were the only independent predictors of a favorable response 3 months after intracoronary administration of BMCs. During extended clinical follow-up (577 +/- 442 days), a total of 14 deaths occurred in the overall patient population. Kaplan-Meier curves for both all cause and cardiac mortality showed that patients receiving a higher number of colony-forming cells were significantly less likely to die than those patients receiving low numbers of colony-forming cells (P=0.01). Most importantly, infusion of a high number of cells with colony-forming capacity was associated with a complete abrogation of increased mortality in patients with elevated NT-proBNP serum levels (>= 735 pg/mL; median) at baseline (P