Association between High Endocardial Unipolar Voltage and Improved Left Ventricular Function in Patients with Ischemic Cardiomyopathy.

Publisher: published in the Cardiovascular Surgical Research Laboratories, Texas Heart Institute Country of Publication: United States NLM ID: 8214622 Publication Model: eCollection Cited Medium: Internet ISSN: 1526-6702 (Electronic) Linking ISSN: 07302347 NLM ISO Abbreviation: Tex Heart Inst J Subsets: MEDLINE

Original Publication: Houston, TX : published in the Cardiovascular Surgical Research Laboratories, Texas Heart Institute, c1982-

Stroke Volume* ; Ventricular Function, Left*; Bone Marrow Transplantation/*methods ; Cardiomyopathies/*surgery ; Endocardium/*physiopathology ; Heart Failure/*surgery ; Myocardial Ischemia/*complications ; Ventricular Dysfunction, Left/*surgery; Action Potentials ; Aged ; Bone Marrow Transplantation/adverse effects ; Cardiomyopathies/diagnosis ; Cardiomyopathies/etiology ; Cardiomyopathies/physiopathology ; Clinical Trials, Phase II as Topic ; Electrophysiologic Techniques, Cardiac ; Female ; Heart Failure/diagnosis ; Heart Failure/etiology ; Heart Failure/physiopathology ; Humans ; Injections ; Male ; Middle Aged ; Myocardial Ischemia/diagnosis ; Myocardial Ischemia/physiopathology ; Randomized Controlled Trials as Topic ; Recovery of Function ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Ventricular Dysfunction, Left/diagnosis ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/physiopathology

We know that endocardial mapping reports left ventricular electrical activity (voltage) and that these data can predict outcomes in patients undergoing traditional revascularization. Because the mapping data from experimental models have also been linked with myocardial viability, we hypothesized an association between increased unipolar voltage in patients undergoing intramyocardial injections and their subsequent improvement in left ventricular performance. For this exploratory analysis, we evaluated 86 patients with left ventricular dysfunction, heart-failure symptoms, possible angina, and no revascularization options, who were undergoing endocardial mapping. Fifty-seven patients received bone marrow mononuclear cell (BMC) injections and 29 patients received cell-free injections of a placebo. The average mapping site voltage was 9.7 ± 2 mV, and sites with voltage of ≥6.9 mV were engaged by needle and injected (with BMC or placebo). For all patients, at 6 months, left ventricular ejection fraction (LVEF) improved, and after covariate adjustment this improvement was best predicted by injection-site voltage. For every 2-mV increase in baseline voltage, we detected a 1.3 increase in absolute LVEF units for all patients (P=0.038). Multiple linear regression analyses confirmed that voltage and the CD34(+) count present in bone marrow (but not treatment assignment) were associated with improved LVEF (P=0.03 and P=0.014, respectively). In an exploratory analysis, higher endocardial voltage and bone marrow CD34(+) levels were associated with improved left ventricular function among ischemic cardiomyopathy patients. Intramyocardial needle injections, possibly through stimulation of angiogenesis, might serve as a future therapy in patients with reduced left ventricular function and warrants investigation.

Circulation. 2004 Oct 19;110(16):2410-6. (PMID: 15477418)
Pharmacol Ther. 2014 Sep;143(3):305-15. (PMID: 24704323)
Chin Med J (Engl). 2004 Oct;117(10):1443-8. (PMID: 15498362)
Circ Res. 2011 Aug 5;109(4):428-36. (PMID: 21737787)
J Am Coll Cardiol. 2013 May 7;61(18):1860-70. (PMID: 23500234)
JAMA. 2012 Apr 25;307(16):1717-26. (PMID: 22447880)
Circulation. 2002 Aug 20;106(8):957-61. (PMID: 12186800)
Am J Cardiol. 2004 Nov 1;94(9):1129-33. (PMID: 15518606)
J Am Coll Cardiol. 2012 Nov 20;60(21):2194-204. (PMID: 23103045)
N Engl J Med. 2011 Apr 28;364(17):1617-25. (PMID: 21463153)
JACC Cardiovasc Imaging. 2012 May;5(5):559-65. (PMID: 22595165)
J Am Coll Cardiol. 2001 Jul;38(1):91-8. (PMID: 11451302)
J Orthop Res. 2008 Jun;26(6):816-23. (PMID: 18240327)
J Am Coll Cardiol. 2002 Apr 3;39(7):1151-8. (PMID: 11923039)
J Am Coll Cardiol. 2003 Mar 5;41(5):843-8. (PMID: 12628732)
Nat Rev Cardiol. 2011 May 17;8(7):393-404. (PMID: 21587214)
Surgery. 1968 Nov;64(5):861-70. (PMID: 5687838)
Circulation. 1998 Nov 3;98 (18):1837-41. (PMID: 9799201)
J Am Coll Cardiol. 2011 Sep 6;58(11):1095-104. (PMID: 21884944)
N Engl J Med. 2011 Apr 28;364(17):1607-16. (PMID: 21463150)
Circ Cardiovasc Interv. 2014 Apr;7(2):156-67. (PMID: 24668227)
Circulation. 1996 Aug 15;94(4):600-1. (PMID: 8772674)
J Am Coll Cardiol. 2002 Sep 18;40(6):1067-74; discussion 1075-8. (PMID: 12354429)
Circulation. 1995 Nov 1;92(9 Suppl):II58-65. (PMID: 7586462)

F32 HL008736 United States HL NHLBI NIH HHS; UM1 HL087318 United States HL NHLBI NIH HHS; UM1 HL087365 United States HL NHLBI NIH HHS; UM1 HL087366 United States HL NHLBI NIH HHS

Keywords: Bone marrow cells; comparative study; electrophysiologic techniques, cardiac; endocardium; heart failure/therapy; mapping; multicenter study; recovery of function; ventricular dysfunction, left

Date Created: 20160823 Date Completed: 20170823 Latest Revision: 20181113

20240829

PMC4979383

10.14503/THIJ-15-5341

27547135