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Stem cells treatment in chronic ischemic heart disease: a narrative review
Roberto G Carbone1, Simone Negrini1, Giuseppe Murdaca1
1Department of Internal Medicine, University of Genoa Genoa, Italy.
Insights
Stem cell transplantation shows potential benefits for chronic ischemic heart disease, improving cardiac function and reducing symptoms. Further multicenter trials are needed to confirm efficacy, particularly with specific stem cell types.
Area of Science:
- Cardiology
- Regenerative Medicine
Background:
- Chronic ischemic heart disease is a leading cause of death globally.
- Stem cell transplantation is being investigated to improve cardiac function post-myocardial infarction.
Purpose of the Study:
- To review clinical trials on stem cell transplantation for chronic ischemic heart disease without heart failure.
- To analyze the impact on left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) class.
Main Methods:
- Narrative review of 24 clinical trials (2005-2023) involving 1824 patients.
- Analysis of LVEF changes and NYHA class at 6/12 months post-transplantation.
Main Results:
- 13 trials showed statistically significant LVEF increase (4-19%).
- No difference in LVEF between intracoronary and intramyocardial transplantation.
- CD133+ stem cells (bone marrow, peripheral blood) doubled LVEF increase compared to CD133- cells.
- 10 trials reported NYHA class improvement alongside LVEF increase.
Conclusions:
- Stem cell transplantation shows conflicting results for chronic ischemic heart disease.
- Further multicenter randomized trials are essential to establish definitive efficacy.
Abstract:
Chronic ischemic heart disease remains a major cause of morbidity and mortality worldwide. Several trials have been performed to evaluate benefit of stem cells transplantation to restore cardiac function in short- and long-term period after myocardial infarction. This narrative review analyzes 24 clinical trials between 2005 and 2023 comprising 1824 patients with chronic heart disease without heart failure. Percent increase in left ventricular ejection fraction (LVEF) and decrease in New York Heart Association (NYHA) class at 6/12 months after stem cells transplantation are reported. Thirteen trials showed a statistically significant percent LVEF increase between 4% to 19% at 6/12 months after stem cells transplantation (p values from 0.05 to 0.0001). No significant differences in LVEF were observed between patients who underwent intracoronary or intramyocardial transplantation. NYHA class decrease from severe to mild/moderate was demonstrated in 10 trials reporting a significant LVEF increase. Patients transplanted with bone marrow and peripheral blood CD133+ stem cells showed a doubling of percentage LVEF increase in comparison to patients transplanted with CD133- cells. This narrative review reports the conflicting results on this topic. Multicenter randomized clinical trials should be performed to define the efficacy of stem cells transplantation in chronic ischemic heart disease.
