Author + information
- 1Division of Cardiac Surgery, Department of Cardiovascular Diseases, the First Affiliated Hospital of Sun-Yat-sen University
- 2Division of Obstetrics and Gynecology, the First Affiliated Hospital of Jinan University
- 3Division of Laboratory of Respiratory, Department of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University
Bone marrow stem cell therapy as an option for regenerative therapy in chronic ischemic heart disease (IHD) and congestive heart failure was tested in a few randomized controlled trials (RCTs) but with no consistent conclusions regarding salubrious effects in enhancing heart function, remodeling and improving outcomes. Our aim was to provide a pooled estimate of safety and potential benefit of stem cell therapy on these patients.
Relevant RCTs published before Jan. 2017 were collected in a number of databases and analyzed with RevMan 5.3. Primary outcomes were all-cause mortality and left ventricular ejection fraction (LVEF) in the short-term follow-up (< 12 months) and long-term follow-up (more than or equal to 12 months). Secondary outcomes included left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and stroke volume index.
Twenty six RCTs with 1451 patients were included. Pooled analysis showed the bone marrow stem cells (BMSC) treatment had a trend toward lower risk of mortality in the short-term follow-up (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.32 to 1.08, P = 0.09), and significantly reduced the incidence of mortality in the long-term follow-up (RR 0.28, 95% CI 0.15 to 0.55, P = 0.0002). The treatment was also associated with an improvement in LVEF both in the short-term (mean difference (MD) 4.17%, 95% CI 3.42% to 4.92%, P< 0.00001) and long-term follow-up (MD 2.62%, 95% CI 0.50% to 4.73%, P= 0.015). Moreover, the pooled results showed a significant difference in the stroke volume index(3.84, 95% CI: 0.95 to 6.73, P= 0.0093) and the mean LVESV (-5.47 ml, 95% CI: -8.81 ml to-2.14 ml, P= 0.0013), in favor of BMSC therapy in the short-term follow-up. The incidence of adverse event in BMSC-based therapies was generally low in most included studies. No significant difference was noted in other outcomes.
Bone marrow stem cell therapies are generally safe and have a potential beneficial clinical effect on IHD patients with congestive heart failure in the short-term and long-term follow-up.