Autologous Transplantation of Bone Marrow/Blood-Derived Cells for Chronic Ischemic Heart Disease: A Systematic Review and Meta-analysis

• Published in: Canadian journal of cardiology 2014-11, Vol.30 (11), p.1370-1377
• Main Authors: Xu, Rende, MD, PhD, Ding, Song, MD, Zhao, Yichao, MD, Pu, Jun, MD, PhD, He, Ben, MD, PhD
• Format: Article
• Language: English
• Subjects: Bone Marrow Cells - cytology; Bone Marrow Transplantation - methods; Cardiovascular; Cell- and Tissue-Based Therapy - methods; Chronic Disease; Humans; Myocardial Ischemia - therapy; Transplantation, Autologous
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2014.01.013

Abstract Background Studies focused on cell therapy for chronic ischemic heart disease (CIHD) have been published with conflicting results. In this meta-analysis, we aimed to assess the effectiveness and safety of autologous bone marrow/blood-derived cell transplantation in patients with CIHD. Methods Randomized controlled trials (RCTs) were identified in PubMed, OVID, EMBASE, and Cochrane Library reviews and reference lists of relevant articles. Weighted mean difference was calculated for changes in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV) using a random-effects model. Results Nineteen trials with a total of 886 patients were included. Compared with controls, patients who received transplantation of bone marrow/blood-derived cells had significantly improved LVEF (3.54%; 95% confidence interval [CI], 1.92%-5.17%; P < 0.001) and LVESV (−8.96 mL; 95% CI, −13.64 to −4.28 mL; P < 0.001). No significant improvement in LVEDV (−0.75 mL; 95% CI, −9.80-8.30 mL; P  = 0.22) was detected. Subgroup analysis revealed that significant improvement in LVEDV was observed in patients with lower baseline LVEF. Moreover, there were trends in favor of a benefit for LV function and remodelling when intramyocardial cells were injected during coronary bypass surgery and the bone marrow mononuclear cell number was ≤1 × 108 . Furthermore, cell therapy was associated with a significant decrease in all-cause death (relative risk: 0.49; 95% CI, 0.29-0.84; P  = 0.01). Conclusions Current evidence showed that cell therapy moderately improved left ventricle function and significantly decreased all-cause death in patients with CIHD and supports further RCTs with larger sample size and longer follow-up.