GW24-e2985 Stem cell therapy: a meta-analysis of randomised Controlled trials in chronic heart failure

Abstract Introduction Controversies in stem cell research (Anversa retractions) have led many to question the validity of clinical cell therapy research. There is however consistent data supporting the use of cell therapy for chronic IHD. Purpose To update the clinical evidence for the safety and efficacy of autologous adult bone marrow-derived stem/progenitor cells as a treatment for chronic IHD and CHF. Methods A full Cochrane review of relevant trials up to 21st November 2018 was performed. Randomised controlled trials comparing autologous adult stem/progenitor cells with no cells in participants with chronic IHD and CHF were deemed eligible. Trials that involved acute myocardial infarction were excluded. Results In total 41 randomised controlled trials and 2397 patients are included in the meta-analysis. This updated Cochrane review shows a statistically significant reduction in mortality (RR 0.51; 95% CI, 0.37 to 0.68; p≤0.00001) and MACE (RR 0.66; CI 0.55 to 0.80; p<0.00001) seen with cell therapy. This is associated with a significant improvement in symptoms (exercise tolerance, NYHA, CCS) and ejection fraction. Conclusions Cell therapy may be effective for this patient group both for cardiovascular outcomes and symptom control. This conclusion therefore warrants further testing of cell therapy in prospective clinical trials assessing meaningful clinical endpoints. Stem cell therapy and risk of all-cause Funding Acknowledgement Type of funding source: None

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Efficacy and safety of iron therapy in patients with chronic heart failure and iron deficiency: a systematic review and meta-analysis based on 15 randomised controlled trials

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137342 ◽

2020 ◽

pp. postgradmedj-2019-137342

Author(s):

Junyi Zhang ◽

Shengda Hu ◽

Yufeng Jiang ◽

Yafeng Zhou

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Adverse Events ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Iron Therapy ◽

Controlled Trials ◽

Efficacy And Safety ◽

6Mwt Distance ◽

Randomised Controlled

Trials studying iron administration in patients with chronic heart failure (CHF) and iron deficiency (ID) have sprung up these years but the results remain inconsistent. The aim of this meta-analysis was to comprehensively evaluate the efficacy and safety of iron therapy in patients with CHF and ID. A literature search was conducted across PubMed, Embase, Cochrane Library, OVID and Web of Science up to 31 July 2019 to search for randomised controlled trials (RCT) comparing iron therapy with placebo in CHF with ID, regardless of presence of anaemia. Published studies reporting data of any of the following outcomes were included: all-cause death, cardiovascular hospitalisation, adverse events, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), N-terminal pro b-type natriuretic peptide, peak oxygen consumption, 6 min walking test (6MWT) distance and quality of life (QoL) parameters. 15 RCTs with a total of 1627 patients (911 in iron therapy and 716 in control) were included. Iron therapy was demonstrated to reduce the risk of cardiovascular hospitalisation (OR 0.35, 95% CI 0.12 to 0.99, p=0.049), but was ineffective in reducing all-cause death (OR 0.59, 95% CI 0.33 to 1.06, p=0.078) or cardiovascular death (OR 0.80, 95% CI 0.39 to 1.63, p=0.540). Iron therapy resulted in a reduction in NYHA class (mean difference (MD) −0.73, 95% CI −0.99 to −0.47, p<0.001), an increase in LVEF (MD +4.35, 95% CI 0.69 to 8.00, p=0.020), 6MWT distance (MD +35.44, 95% CI 11.55 to 59.33, p=0.004) and an improvement in QoL: EQ-5D score (MD +4.07, 95% CI 0.84 to 7.31, p=0.014); Minnesota Living With Heart Failure Questionnaire score (MD −19.47, 95% CI −23.36 to −15.59, p<0.001) and Patients Global Assessment (PGA) scale (MD 0.71, 95% CI 0.32 to 1.10, p<0.001). There was no significant difference in adverse events or serious adverse events between iron treatment group and control group. Iron therapy reduces cardiovascular hospitalisation in patients with CHF with ID, and additionally improves cardiac function, exercise capacity and QoL in patients with CHF with ID and anaemia, without an increase of adverse events.

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