Cardiomyopathy, Dilated ; surgery ; therapy ; Humans ; Stem Cell Transplantation

OBJECTIVEThe aim of this study is to identify short-term result of cell transplantation in idiopathic dilated cardiomyopathy (IDC) patients who were treated by intracoronary transplantation of autologous mononuclear bone marrow cells (BMCs) in addition to standard therapy.

METHODSBased on given standard therapy, eighteen patients with idiopathic dilated cardiomyopathy were enrolled and divided into transplantation group and control group. The clinical characteristics of two groups were comparable. Among these patients, 10 patients were performed percutaneous coronary autologous BMCs transplantation. Blood routine test, hepatic function, renal function, glucose, triglyceride (TG), cholesterol, low density cholesterol (LDL), high density cholesterol (HDL), uric acid (UA) and high sensitive C-reactive protein (hsCRP) were measured at the time point of pre-operation and some time after transplantation. All patients were monitored under ultrasonic cardiography, Holter, six-minute-walk test and magnetic resonance imaging over a period of at least 6 months. Annual hospital days were recorded during two-year follow-up.

RESULTSBlood routine test, hepatic function, renal function, glucose, TG, cholesterol, LDL, HDL, UA and hsCRP had no significant differences among 48 hours, 3 months and 6 months after transplantation compared with control and pre-transplantation (P > 0.05). Six-minute-walk distance elevated significantly six months after BMCs transplantation compared with control and pre-transplantation [(494.3 +/- 62.8) m vs (307.2 +/- 75.0) m, (321.5 +/- 63.7) m, P < 0.05]. Left ventricular ejection fraction (LVEF) and the sizes of LVEDd had no significant changes compared with that of control and pre-transplantation (P > 0.05). Myocardium lesion area measured by (MRI) seemed decrease in transplantation group compared with that of control and pre-operation [(4.96 +/- 0.47) cm(2) vs (5.12 +/- 0.54) cm(2), (5.02 +/- 0.39) cm(2), P > 0.05], but there was no significance. None of proarrhythmias and side effects had been observed around transplantation and 2 years follow-up. There was no significant difference in survival between two groups in 2 years follow-up. Interestingly, annual hospital day in BMCs transplantation patients was significantly shorter than that in control group [(30.2 +/- 11.2) d vs (43.6 +/- 9.8) d, P < 0.05].

CONCLUSIONSAutologous bone marrow mononuclear cells transplantation can prolong six-minute-walk, decrease re-hospitalization rate, elevate exercise ability and help to improve cardiac function in patients with IDC. In addition, it was demonstrated that cell transplantation is safe.

Bone Marrow Transplantation ; Cardiomyopathy, Dilated ; surgery ; therapy ; Humans ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo compare the effects of intracoronary infusion of mononuclear stem cells (MNCs) or mesenchymal stem cells (MSCs) in patients with dilated cardiomyopathy (DCM).

METHODSDCM patients with left ventricular ejection fraction(LVEF) < 40% were randomized to intracoronary infusion of MNCs [(5.1 ± 2.0) × 10(8), n = 16] or MSCs [(4.9 ± 1.7) × 10(8), n = 17] or equal volume normal saline (n = 20) through the guiding catheter. Changes of left ventricular end-diastolic diameter (LVEDd), LVEF and myocardium perfusion defects were assessed before and at (30 ± 3) days and (90 ± 7) days after the procedure. Malignant cardiovascular events were also recorded.

RESULTS(1) One month after the procedure, LVEF in transplantation groups significantly increased compared to before procedure (all P < 0.05), and significant increase of LVEF was observed only in MSCs transplantation group compared to control group (P < 0.05). However, absolute changes of LVEDd and perfusion defects of myocardium were similar among and within groups (P > 0.05). (2) Comparing with before procedure and control group, LVEF in transplantation groups increased significantly in three months after the procedure (P < 0.05), but there were no significant differences between transplantation groups (P > 0.05). LVEDd and myocardium perfusion defects in transplantation groups improved significantly compared with that of before procedure (P < 0.05), while significant decrease of myocardium perfusion defects was only observed in patients treated with MSCs compared with control group at three months after procedure (P < 0.05). (3) There were no significant differences in major cardiovascular events between transplantation group and control during follow-up (P > 0.05).

CONCLUSIONSIntracoronary bone marrow stem cells transplantation is safe and effective for DCM patients while the efficacy of MSCs and MNCs transplantation is comparable.

Adult ; Aged ; Bone Marrow Transplantation ; Cardiomyopathy, Dilated ; surgery ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo evaluate the long-term outcome of dynamic cardiomyoplasty in patients with dilated cardiomyopathy.

METHODSThree male patients with dilated cardiomyopathy at age of 36, 45 and 62 years were underwent dynamic cardiomyoplasty from 1994 to 1995. Postoperative follow-up were performed. The data of hemodynamic parameters, functional grade and dimension of heart were analyzed.

RESULTSThere was no operative death in these patients. All patients recovered eventlessly. From early postoperative stage, the hemodynamic parameters and clinical symptoms were improved and the patients' exercise tolerance augmented. The quality of life of patients was enhanced significantly. All patients showed NYHA functional grade I. One patient died of severe arrhythmia at the 19th postoperative month. In 2 long-term survivors, the hemodynamic parameters and heart function were declined and the heart tended to be dilated after 3 postoperative years. One patient died of congestive heart failure at 4.5 postoperative years. One patient still survived 7 years after operation and remained heart functional grade II.

CONCLUSIONSDynamic cardiomyoplasty can significantly improve the functional class and quality of life in patients with dilated cardiomyopathy within a considerable long postoperative period.

Adult ; Cardiomyopathy, Dilated ; physiopathology ; psychology ; surgery ; Cardiomyoplasty ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Quality of Life ; Treatment Outcome

Cardiac resynchronization therapy is known to reduce morbidity and mortality in patients with advanced heart failure as a result of dyssynchrony and systolic dysfunction of the left ventricle. Placement of the left ventricular (LV) lead via the coronary sinus can be difficult. When LV lead implantation is difficult, a video-assisted epicardial approach can be a good alternative. Although there are several reports of video-assisted epicardial LV lead implantation, mini-thoracotomy and lead implantation under direct vision have been used in most series. A 49-yr-old woman with dilated cardiomyopathy underwent the video-assisted epicardial LV lead implantation because percutaneous transvenous approach was difficult due to small cardiac veins. The patient was discharged without problems and showed improved cardiac function at the 3 follow-up months. We report the first successful total thoracoscopic LV lead implantation (without mini-thoracotomy) in Korea.
*Cardiac Resynchronization Therapy ; Cardiomyopathy, Dilated/diagnosis ; *Defibrillators, Implantable ; Echocardiography ; Female ; Humans ; Middle Aged ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed ; Ventricular Dysfunction, Left/radiography/surgery/*therapy

OBJECTIVETo evaluate the discrepancy between pre- and post-transplant diagnosis of end-stage dilated cardiomyopathy, a pre-transplantation diagnosis was compared with the diagnosis made after macroscopic and microscopic examination of the explanted hearts in 40 cardiac transplant recipients who had undergone cardiac transplantation at our institute.

METHODSPre-operation echocardiograms were obtained in all patients and coronary angiogram was obtained in 9 patients who had significant risk factors for coronary heart disease (CHD). CHD was considered present when there was a 75% reduction in cross-sectional luminal area of >or= 1 major coronary artery. Idiopathic dilated cardiomyopathy (IDC) was diagnosed when ventricular dilation and global reduction in ventricular systolic function were present in the absence of any identifiable cause. IDC patients with an alcohol consumption of > 100 g/day during the last 12 months before the onset of congestive heart failure were classified as having alcoholic cardiomyopathy. The pathological diagnosis of arrhythmogenic right ventricular cardiomyopathy was formulated in the presence of gross/or histological evidence of regional or diffuse transmural fatty or fibrofatty infiltration of the right ventricular free wall.

RESULTSBefore transplantation, 45.0%, 17.5%, 17.5% and 7.5% of patients were classified as IDC, CHD, alcoholic cardiomyopathy and hypertrophic cardiomyopathy. Post-transplant CHD diagnosis was made in all patients with a pre-transplant diagnosis of CHD. Post-transplant CHD diagnosis was also established in 4 patients with a pre-transplant diagnosis of IDC, in 4 patients with presumptive alcoholic cardiomyopathy, in 1 patient with hypertensive cardiomyopathy and in 1 patient with a pre-transplant diagnosis of aortic valve disease. Post-transplant arrhythmogenic right ventricular cardiomyopathy diagnosis was made in 6 patients with a pre-transplant diagnosis of IDC or KaShan disease. Post-transplant giant cell myocarditis diagnosis was made in 1 patient with a pre-transplant diagnosis of IDC.

CONCLUSIONPost-transplant CHD diagnosis is significantly higher than that of pre-transplant (42.5% vs. 17.5%, P < 0.05). Part of these patients might benefit from bypass surgery or PCI. Therefore, "in-depth" search for a heart failure cause, especially the coronary angiography examination, should be conducted in all heart transplantation candidates due to heart failure, regardless of their clinical presentation.

Adolescent ; Adult ; Cardiomyopathy, Dilated ; diagnosis ; pathology ; surgery ; Heart Failure ; diagnosis ; pathology ; Heart Transplantation ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stroke Volume

The diagnosis of dilated cardiomyopathy associated with pheochromocytoma was made in a 24 year old male on the basis of symptoms and signs, measurements of metabolites of catecholamine,echocardiography and radionuclide ventriculography were preformed and demonstrated. The presence of a tumor on both adrenal glands without definite distant metastasis was demonstrated by abdominal ultrasonography, CT scanning and 131I-MIBC scintigraphy. Surgical removal was performed after proper preoperative preparation with a-adrenergic blocker. During the surgery, neither significant arrhythmia nor severe change of blood pressure was observed. After surgery, cardiac function of the patient improved slowly and progressively.
Adrenal Glands ; Arrhythmias, Cardiac ; Blood Pressure ; Cardiomyopathy, Dilated* ; Diagnosis ; Humans ; Male ; Neoplasm Metastasis ; Pheochromocytoma* ; Radionuclide Imaging ; Radionuclide Ventriculography ; Thoracic Surgery ; Tomography, X-Ray Computed ; Ultrasonography ; Young Adult

OBJECTIVERecent experimental and clinical observations have suggested that cell transplantation could be of therapeutic value for the treatment of heart failure. This study was performed to explore the efficacy and safety of intracoronary autologous mesenchymal stem cells (MSCs) transplantation for treating patients with idiopathic dilated cardiomyopathy.

METHODTwenty-four consecutive patients with idiopathic dilated cardiomyopathy received standard drug therapy were randomly divided into intracoronary injection of autologous mesenchymal stem cells (treated, n = 12) or saline (control, n = 12) groups. Serum IL-6, TNF-alpha and CRP, plasma brain natriuretic peptides (BNP) were determined and echocardiography, Holter electrocardiogram monitoring and six minutes walk test were performed at baseline, 3 and 6 months post injection.

RESULTSIL-6, TNF-alpha and CRP remained unchanged after MSCs transplantation. Plasma BNP levels at 3 months and 6 months post MSCs injection were significantly higher than that of pre-injection (378.10 +/- 147.47, 420.40 +/- 148.50 vs. 292.40 +/- 148.54 ng/L, respectively, P < 0.05) but were significantly lower than that in control group at comparable time points (3 months: 378.10 +/- 147.47 vs. 473.10 +/- 106.31 ng/L; 6 months: 420.40 +/- 148.50 vs. 544.60 +/- 93.11 ng/L, P < 0.05). Six-minute-walking distance significantly increased at 6 months after MSCs injection compared with pre-injection level and which is also higher than that in control patients (519.00 +/- 43.28 vs. 396.33 +/- 42.19 and 464.00 +/- 76.5 m, respectively, P < 0.05). Left ventricular ejection fraction and LVEDd remained unchanged post MSCs injection. No malignant arrhythmias and severe side effects could be observed around transplantation and during six months follow-up. Survival was similar between the two groups during six months follow-up.

CONCLUSIONPercutaneous coronary autologous mesenchymal stem cells transplantation can attenuate the increase of plasma BNP, increase six-minute-walking capacity in patients with idiopathic dilated cardiomyopathy.

Aged ; Cardiomyopathy, Dilated ; surgery ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Mesenchymal Stem Cell Transplantation ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Prospective Studies ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVE: Mutations in LIM domain binding 3 (LDB3) gene cause idiopathic dilated cardiomyopathy (IDCM), a structural heart disease with a complicated genetic background. However, the association of polymorphisms in the LDB3 gene with susceptibility to IDCM in Chinese populations remains unexplored as dose the impact on clinical presentation. METHODS: We sequenced all exons and the adjacent part of introns of the LDB3 gene in 159 Chinese Han IDCM patients and 247 healthy controls. Then we detected the distribution of polymorphisms in the LDB3 gene in all participants and assessed their associations with risk of IDCM. Additionally, we conducted a stratified genotype-phenotype correlation analysis. RESULTS: The A allele of rs4468255 was significantly associated with IDCM (P<0.01). The rs4468255, rs11812601, rs56165849, and rs3740346 were also associated with diastolic blood pressure (DBP) and left ventricular ejection fraction (LVEF) (P<0.05). Notably, a higher frequency of rs4468255 polymorphism was observed in implantable cardioverter defibrillator (ICD) recipients under a recessive model (P<0.01), whereas the significant association disappeared after adjusting for potential confounders. However, in the dominant model, notable correlations could only be observed after adjusting for multi parameters. CONCLUSIONS The rs4468255 was significantly correlated with IDCM of Chinese Han population. A allele of rs4468255 is higher in IDCM patients with ICD implantation, suggesting the influence of genetic background in the generation of this response. In addition, rs11812601, rs56165849, and rs3740346 in LDB3 show association with brain natriuretic peptide, DBP, and LVEF levels in patients with IDCM but did not show any association with IDCM susceptibility.
Adaptor Proteins, Signal Transducing/genetics* ; Adult ; Aged ; Alleles ; Asian People ; Cardiomyopathy, Dilated/surgery* ; China/epidemiology* ; Defibrillators, Implantable ; Exons ; Female ; Genetic Association Studies ; Genetic Predisposition to Disease ; Genotype ; Humans ; LIM Domain Proteins/genetics* ; Linkage Disequilibrium ; Male ; Middle Aged ; Mutation ; Polymorphism, Genetic ; Sequence Analysis, DNA