Abstract 14451: Bone Marrow Cell Therapy Improves Cardiac Function, Survival, and Clinical Outcomes in Patients With Chronic Ischemic Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jane Ha ◽  
Muhammad R Afzal ◽  
Anweshan Samanta ◽  
Ewa Zuba-Surma ◽  
Ji Yoo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Bone Marrow ◽  
Heart Disease ◽  
Cardiac Function ◽  
Ischemic Heart Disease ◽  
Clinical Outcomes ◽  
Ventricular Arrhythmias ◽  
Marrow Cell ◽  
Meta Analysis ◽  
Chronic Ischemic Heart Disease

Introduction: The effects of bone marrow cell (BMC) therapy in patients with chronic ischemic heart disease (CIHD) remain controversial. Hypothesis: We hypothesized that injection of BMCs in patients with CIHD would improve left ventricular (LV) structure and function. We also hypothesized that BMC therapy would improve clinical outcomes in CIHD patients. Methods: We performed a systemic review and meta-analysis of pooled data from published randomized controlled trials (RCTs) that evaluated the efficacy of BMC administration in patients with CIHD. The effects of BMC injection on LV ejection fraction (LVEF), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), infarct size, and patient outcomes were analyzed using random-effects meta-analysis. Results: The literature search yielded 30 RCTs enrolling 1,548 patients. Transplantation of BMCs resulted in an improvement in LVEF in cell-treated patients compared with controls (2.89%; 95% confidence interval (CI): 1.80 to 3.97; P <0.001). There was a trend toward reduced LVESV (-4.96 ml; 95% CI: -11.64 to 1.71 ml; P = 0.14) and LVEDV (-5.95 ml; 95% CI: -12.09 to 0.18 ml; P =0.06). The improvement in LVEDV was more pronounced (-7.42 ml; 95% CI: -13.68 to -1.17ml; P =0.02) in patients with baseline LVEF <40%, indicating improved LV remodeling. BMC injection was also associated with marked reduction in the risk of all-cause mortality, rehospitalization due to heart failure, and ventricular arrhythmias in CIHD patients. Conclusions: BMC injection improves cardiac function and remodeling in patients with CIHD. These benefits are more pronounced in patients with LVEF <40% at baseline. Perhaps more importantly, BMC therapy also improves clinical outcomes that are critically important for this patient population with LV dysfunction, including survival, rehospitalization due to heart failure, and ventricular arrhythmias.

Abstract 16619: Bone Marrow Cell Therapy Improves Left Ventricular Function And Survival in Patients With Chronic Ischemic Heart Disease and Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Anweshan Samanta ◽  
Muhammad R Afzal ◽  
Briha Ansari ◽  
Vinodh Jeevanantham ◽  
Buddhadeb Dawn
Keyword(s):  
Heart Failure ◽  
Bone Marrow ◽  
Heart Disease ◽  
Clinical Outcomes ◽  
Marrow Cell ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Chronic Ischemic Heart Disease ◽  
Scar Size

Introduction: Results from randomized controlled trials (RCTs) of bone marrow cell (BMC) therapy for cardiac repair have been discordant. The true impact of BMC therapy in patients with chronic ischemic heart disease (CIHD) and ischemic heart failure remain unclear. Hypothesis: We hypothesized that BMC injection would improve clinical outcomes and left ventricular (LV) parameters in patients with CIHD. Methods: We performed a systematic review and meta-analysis of data from RCTs of BMC therapy on LV ejection fraction (LVEF), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), infarct scar size, and clinical outcomes in patients with CIHD. Database searches based on specified criteria identified 15 eligible RCTs (enrolling 648 CIHD patients). Changes in predefined parameters were analyzed with random-effects meta-analysis. Peto odds ratio (OR) was calculated for clinical outcomes. Results: Compared with standard therapy, BMC transplantation improved LVEF (3.84%; 95% confidence interval [CI], 2.30 to 5.38; P<0.00001), reduced scar size (-5.90%; 95% CI, -8.03 to -3.78; P<0.00001) and LVESV (-10.37 ml; 95% CI, (-18.56 to -2.18; P=0.01). Reduction in LVEDV (-1.84 ml; 95% CI, -9.13 to 5.46; P=0.62) was not significant. The improvement in LVEF in BMC-treated patients was also significant (1.78%; 95% CI: 0.63 to 2.93; P=0.002) in a separate analysis of RCTs that used MRI. Importantly, BMC therapy reduced all-cause mortality (OR: 0.35; 95% CI 0.16 to 0.73; P=0.005) and incidence of cerebrovascular accident (CVA) (OR: 0.07; 95% CI, 0.01 to 0.55; P=0.01) and tended to reduce the incidence of heart failure (OR: 0.36; 95% CI 0.11 to 1.14; P=0.08) in patients with CIHD (Table). Conclusions: BMC therapy improves LVEF, LVESV, and infarct scar size in patients with CIHD. The improvement in LVEF was also confirmed in meta-analysis of RCTs using MRI. Importantly, these numerically small benefits translated into improved clinical outcomes in BMC-treated CIHD patients.

Electrophysiological and arrhythmogenic effects of intramyocardial bone marrow cell injection in patients with chronic ischemic heart disease

Heart Rhythm ◽  
2007 ◽  
Vol 4 (3) ◽  
pp. 257-265 ◽  
Author(s):  
Saskia L.M.A. Beeres ◽  
Katja Zeppenfeld ◽  
Jeroen J. Bax ◽  
Petra Dibbets-Schneider ◽  
Marcel P.M. Stokkel ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Bone Marrow Cell ◽  
Marrow Cell ◽  
Ischemic Heart ◽  
Chronic Ischemic Heart Disease ◽  
Cell Injection ◽  
Arrhythmogenic Effects

Abstract 16655: Bone Marrow Cell Therapy in Patients With Ischemic Heart Disease: A Meta-analysis of Randomized Controlled Trials Using Cardiac MRI

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Muhammad R Afzal ◽  
Anweshan Samanta ◽  
Briha Ansari ◽  
Vinodh Jeevanantham ◽  
Buddhadeb Dawn
Keyword(s):  
Bone Marrow ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Randomized Controlled Trials ◽  
Bone Marrow Cell ◽  
Cardiac Mri ◽  
Marrow Cell ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

Introduction: The results from clinical trials of bone marrow cell (BMC) therapy in ischemic heart disease (IHD) have been discordant with regard to left ventricular (LV) functional improvement. This discrepancy has been attributed, in part, to the use of dissimilar cardiac imaging modalities. MRI is the gold standard for assessment of cardiac structure/function. Hypothesis: We hypothesized that BMC therapy will improve LV parameters in patients with IHD when assessed by cardiac MRI. Methods: We performed a systematic review and meta-analysis of data from randomized controlled trials (RCTs) of BMC therapy in patients with IHD that used cardiac MRI. Database searches through May 30, 2015 identified 27 eligible RCTs (enrolling 1826 patients). The MRI data on LV ejection fraction (EF), infarct size, LV end-systolic volume (LVESV), and LV end-diastolic volume (LVEDV) were analyzed with random-effects meta-analysis. Clinical outcomes were analyzed using Peto odds ratio (OR). Results: Compared with standard therapy, BMC therapy improved LVEF (1.62%; 95% confidence interval [CI]: 0.49 to 2.75; P=0.005) and reduced LVESV (-2.00 ml; 95% CI: -3.19 to -0.82; P=0.0009). The improvement in LVEF was similar in patients with acute myocardial infarction (MI) and chronic IHD. Perhaps more importantly, BMC therapy was associated with reduced incidence of recurrent MI (OR: 0.39; 95% CI: 0.20 to 0.78; P=0.007) along with substantial improvement in other outcome parameters, including mortality (Table). However, these changes did not reach statistical significance perhaps due to smaller patient numbers. Conclusions: These results from meta-analysis of RCTs using cardiac MRI indicate that BMC therapy improves LV function and outcomes in patients with IHD. These data may help resolve the controversy regarding whether the reported benefits of BMC therapy are dependent on the selection of imaging modalities.

scholarly journals Profoundly Reduced Neovascularization Capacity of Bone Marrow Mononuclear Cells Derived From Patients With Chronic Ischemic Heart Disease

Circulation ◽  
2004 ◽  
Vol 109 (13) ◽  
pp. 1615-1622 ◽  
Author(s):  
Christopher Heeschen ◽  
Ralf Lehmann ◽  
Jörg Honold ◽  
Birgit Assmus ◽  
Alexandra Aicher ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Mononuclear Cells ◽  
Ischemic Heart ◽  
Bone Marrow Mononuclear Cells ◽  
Chronic Ischemic Heart Disease
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