Abstract
Stem cell transplantation (SCT) has become a promising way to treat ischemic heart failure (IHF). We performed a large-scale meta-analysis of randomized clinical trials to investigate the efficacy and safety of SCT in IHF patients. Randomized controlled trials (RCTs) involving stem cell transplantation for the treatment of IHF were identified by searching the PubMed, EMBASE, SpringerLink, Web of Science, and Cochrane Systematic Review databases as well as from reviews and the reference lists of relevant articles. Fourteen eligible randomized controlled trials were included in this study, for a total of 669 IHF patients, of which 380 patients were treated with SCT. The weighted mean difference (WMD) was calculated for changes in the New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV), and Canadian Cardiovascular Society (CCS) angina grade using a fixed effects model, while relative risk (RR) was used for mortality. Compared with the control group, SCT significantly lowered the NYHA class (MD = − 0.73, 95% CI − 1.32 to − 0.14, P < 0.05), LVESV (MD = − 14.80, 95% CI − 20.88 to − 8.73, P < 0.05), and CCS grade (MD = − 0.81, 95% CI − 1.45 to − 0.17, P < 0.05). Additionally, SCT increased LVEF (MD = 6.55, 95% CI 5.93 to 7.16, P < 0.05). However, LVEDV (MD = − 0.33, 95% CI − 1.09 to 0.44, P > 0.05) and mortality (RR = 0.86, 95% CI 0.45 to 1.66, P > 0.05) did not differ between the two groups. This meta-analysis suggests that SCT may contribute to the improvement of LVEF, as well as the reduction of the NYHA class, CCS grade, and LVESV. In addition, SCT does not affect mortality.
Highlights
Ischemic heart disease (IHD), one of the leading causes of morbidity and mortality around the world, occurs when the myocardial oxygen supply cannot meet the myocardial oxygen demand [1, 2]
Following a screen of the titles, abstracts, and full texts, we found 14 eligible randomized clinical trials (Fig. 1) [2, 3, 6–8, 11–13, 24–29]
This study demonstrated the following: (i) stem cell transplantation (SCT) was associated with a significant improvement in left ventricular ejection fraction (LVEF), with no effect on mortality, (ii) SCT significantly and moderately reduced left ventricular end-systolic volume (LVESV), but not left ventricular end-diastolic volume (LVEDV), and (iii) ischemic heart failure (IHF) symptoms, as indicated by the New York Heart Association (NYHA) functional class and Cardiovascular Society (CCS) grade, significantly decreased with SCT
Summary
Ischemic heart disease (IHD), one of the leading causes of morbidity and mortality around the world, occurs when the myocardial oxygen supply cannot meet the myocardial oxygen demand [1, 2]. Revascularization to revive stunned or hibernating myocardium is beneficial for IHD patients, but the ventricular remodeling process is usually irreversible, in end-stage IHD patients [3]. When IHD reaches an advanced stage, further revascularization and medical therapy may be useless [3–6]. The injured myocardium often disappears and is replaced by scar tissue, thereby resulting in systolic dysfunction, myocardial remodeling, and heart failure [5, 7]. Stem cell transplantation (SCT) has become a new treatment strategy to improve cardiac function in patients with advanced ischemic heart failure [8]. SCT functions to enhance tissue perfusion contribute to new blood vessel growth and preserve or even regenerate myocardial tissue [9–11]. The first case of applying SCT to treat myocardial infarction occurred in 2001, which ushered in the clinical trials of utilizing stem cell transplantation to treat ischemic heart failure (IHF). More clinical studies have focused on this method and indicated that stem cells are safe, Wang et al Stem Cell Research & Therapy (2019) 10:125 exhibit few treatment-related adverse events, and do not increase the incidence of major adverse cardiac events in comparison with control groups [11–14]
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