间充质前体细胞可降低缺血性心力衰竭合并炎症的死亡率和主要发病率:DREAM-HF。

IF 16.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Emerson C Perin, Kenneth M Borow, Timothy D Henry, Margaret Jenkins, Olga Rutman, Jack Hayes, Christopher W James, Eric Rose, Hicham Skali, Silviu Itescu, Barry Greenberg
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引用次数: 0

摘要

目的:骨髓衍生的促炎症性心脏巨噬细胞和胚胎衍生的修复性心脏常驻巨噬细胞之间的心肌平衡发生改变,会对射血分数降低的进行性心力衰竭(HFrEF)产生不利影响。间充质前体细胞(MPCs)可恢复这种平衡,改善炎症时的临床预后。研究的目的是:(i) 确定DREAM-HF试验中HFrEF对照组患者心血管死亡(CVD)的危险因素;(ii) 确定间充质前体细胞是否能改善缺血性HFrEF和炎症高危患者的主要临床结局(CVD、心肌梗死[MI]、中风):采用病因特异性回归分析确定 DREAM-HF 对照组患者的心血管疾病风险因素。采用阿伦-约翰森累积发病率曲线,按缺血性与非缺血性 HFrEF 以及有或无基线炎症患者的治疗组别,检查心血管疾病、2 点主要不良心血管事件(MACE)(心肌梗死或中风)和 3 点 MACE(心血管疾病或心肌梗死或中风)。在 DREAM-HF 对照组患者中,炎症(基线血浆高敏 C 反应蛋白≥2 毫克/升;p = 0.003)和缺血性 HFrEF 病因(p = 0.097)是导致心血管疾病风险最大的因素,分别增加了 61% 和 38% 的心血管疾病风险。在30个月的平均随访期间,与对照组相比,MPCs可使缺血性HFrEF和炎症患者的2点和3点MACE分别减少88%(p = 0.005)和52%(p = 0.018):结论:缺血性病因和炎症是DREAM-HF对照组患者MACE的主要风险因素。在缺血性 HFrEF 和炎症患者中,单次心肌内注射 MPC 能最显著、最持久地降低 2 分和 3 分 MACE。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mesenchymal precursor cells reduce mortality and major morbidity in ischaemic heart failure with inflammation: DREAM-HF.

Aims: Progressive heart failure with reduced ejection fraction (HFrEF) is adversely affected by alterations in the myocardial balance between bone marrow-derived pro-inflammatory cardiac macrophages and embryo-derived reparative cardiac resident macrophages. Mesenchymal precursor cells (MPCs) may restore this balance and improve clinical outcomes when inflammation is present. The purpose was to (i) identify risk factors for cardiovascular death (CVD) in control patients with HFrEF in the DREAM-HF trial, and (ii) determine if MPCs improve major clinical outcomes (CVD, myocardial infarction [MI], stroke) in high-risk patients with ischaemic HFrEF and inflammation.

Methods and results: Cause-specific regression analyses were used to identify CVD risk factors in DREAM-HF control patients. Aalen-Johansen cumulative incidence curves were used to examine CVD, 2-point major adverse cardiovascular events (MACE) (MI or stroke), and 3-point MACE (CVD or MI or stroke) by treatment group in ischaemic vs non-ischaemic HFrEF and in patients with or without baseline inflammation. In control DREAM-HF patients, factors portending the greatest risk for CVD were inflammation (baseline plasma high-sensitivity C-reactive protein ≥2 mg/L; p = 0.003) and ischaemic HFrEF aetiology (p = 0.097), with increased CVD risk of 61% and 38%, respectively. Over 30-month mean follow-up, MPCs reduced 2-point and 3-point MACE by 88% (p = 0.005) and 52% (p = 0.018), respectively, in patients with ischaemic HFrEF and inflammation compared to controls.

Conclusion: Ischaemic aetiology and inflammation were identified as major risk factors for MACE in control DREAM-HF patients. A single intramyocardial MPC administration produced the most significant, sustained reduction in 2-point and 3-point MACE in patients with ischaemic HFrEF and inflammation.

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来源期刊
European Journal of Heart Failure
European Journal of Heart Failure 医学-心血管系统
CiteScore
27.30
自引率
11.50%
发文量
365
审稿时长
1 months
期刊介绍: European Journal of Heart Failure is an international journal dedicated to advancing knowledge in the field of heart failure management. The journal publishes reviews and editorials aimed at improving understanding, prevention, investigation, and treatment of heart failure. It covers various disciplines such as molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, clinical sciences, social sciences, and population sciences. The journal welcomes submissions of manuscripts on basic, clinical, and population sciences, as well as original contributions on nursing, care of the elderly, primary care, health economics, and other related specialist fields. It is published monthly and has a readership that includes cardiologists, emergency room physicians, intensivists, internists, general physicians, cardiac nurses, diabetologists, epidemiologists, basic scientists focusing on cardiovascular research, and those working in rehabilitation. The journal is abstracted and indexed in various databases such as Academic Search, Embase, MEDLINE/PubMed, and Science Citation Index.
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