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Updated: May 30, 2025
Intramyocardial Cell Delivery: Observations in Murine Hearts
Published on: January 24, 2014
Safety and Efficacy of Transendocardial Stem Cells Therapy in Chronic Ischemic Heart Failure: A Systematic Review and
Ibrahim Al- Sawalha1, Abdel Qader Abu- Salih2, Mohammad Al- Bdour2
1Department of Medicine, Princess Basma Teaching Hospital, Irbid, Jordan.
Insights
Stem cell therapy shows promise for improving cardiac function in heart failure, reducing LVESV and improving SPECT outcomes. However, its impact on ejection fraction remains uncertain, requiring further investigation.
Area of Science:
- Cardiology
- Regenerative Medicine
- Biomedical Engineering
Background:
- Chronic ischemic heart failure presents a significant global health challenge.
- Advancements in therapy have been made, yet effectiveness remains uncertain.
- Stem cell (SC) therapy is a potential therapeutic approach under investigation.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of stem cell therapy for chronic ischemic heart failure.
- To evaluate the impact of stem cell therapy on cardiac function and safety outcomes.
Main Methods:
- Comprehensive literature search of PubMed, Embase, and Cochrane databases up to April 2024.
- Inclusion of blinded randomized controlled trials (RCTs) in patients with heart failure with reduced ejection fraction (HFrEF).
- Meta-analysis using a random-effects model with sensitivity analyses to assess heterogeneity.
Main Results:
- Significant improvements in left ventricular end-systolic volume (LVESV) and stress SPECT outcomes with stem cell therapy.
- Sensitivity analysis revealed significant benefits in left ventricular end-diastolic function (LVEDF).
- No significant effects observed on left ventricular ejection fraction (LVEF) or myocardial oxygen consumption (MVO2); functional improvements noted in NYHA classification.
Conclusions:
- Transendocardial stem cell therapy demonstrates potential for improving specific cardiac parameters in heart failure.
- The impact on LVEF and MVO2 requires further research to establish conclusive evidence.
- Current evidence suggests promise but highlights the need for continued investigation into stem cell therapy for heart failure.
Introduction:
Chronic ischemic heart failure is a major global health issue despite advancements in therapy. Stem cell (SC) therapy has emerged as a potential treatment, but its effectiveness remains uncertain. This study aimed to systematically review and meta-analyze the current evidence on SC therapy's efficacy.
Methods:
We conducted a comprehensive literature search in PubMed, Embase, and Cochrane databases up to April 2024. We included randomized controlled trials (RCTs) with blinded designs, focusing on patients with heart failure with reduced ejection fraction (HFrEF) treated with mesenchymal stem cells compared to placebo or sham interventions via percutaneous endomyocardial catheter systems. Data extraction, performed independently by two authors, focused on safety and efficacy variables. The meta-analysis used a random-effects model, with sensitivity analyses to address study heterogeneity.
Results:
Twenty studies were included in the meta-analysis. Significant improvements were observed in the stem cell group for left ventricular end-systolic volume (LVESV) (pooled effect size -7.59, 95% CI [-12.28 to -2.89], P=0.002) and stress SPECT outcomes (pooled effect size - 5.33, 95% CI [-6.73 to -3.93], P<0.00001). Sensitivity analysis reduced heterogeneity in left ventricular end-diastolic function (LVEDF) (P=0.01, I²=54%) and revealed a significant benefit for stem cell therapy (pooled effect size -3.87, 95% CI [-6.77 to -0.97], P=0.009). No significant effects were observed for left ventricular ejection fraction (LVEF) or myocardial oxygen consumption (MVO2). Functional improvements in New York Heart Association (NYHA) classification were noted (OR=4.22, 95% CI (1.14-15.68), P=0.03), though no significant differences were found in safety outcomes, including major cardiovascular events, mortality, or rehospitalization rates.
Conclusion:
Transendocardial SC therapy shows promise in improving certain cardiac parameters, though its impact on LVEF and MVO2 remains inconclusive, indicating the need for further research.
