Evaluating the Efficacy of Stem Cell Therapy in the Treatment of Ischemic Heart Failure: A Systematic Review and Meta-Analysis

Abstract:

Ischemic heart failure (IHF) is a leading cause of morbidity and mortality worldwide, with limited treatment options available. Stem cell therapy has emerged as a promising approach for the treatment of IHF, with numerous studies suggesting its potential benefits. However, the existing literature is characterized by heterogeneity and inconsistency, making it challenging to draw definitive conclusions. This systematic review and meta-analysis aimed to evaluate the efficacy of stem cell therapy in the treatment of IHF, with a focus on its effects on left ventricular function, exercise capacity, and clinical outcomes.

Methods:

A comprehensive search of major electronic databases, including PubMed, Scopus, and Embase, was conducted to identify relevant studies published between January 2000 and December 2022. Studies were included if they were randomized controlled trials (RCTs) or observational studies that investigated the use of stem cells in patients with IHF. The primary outcomes of interest were left ventricular ejection fraction (LVEF), exercise capacity (6-minute walk test), and clinical outcomes (composite endpoint of death, myocardial infarction, and hospitalization for heart failure).

Results:

A total of 34 studies, including 23 RCTs and 11 observational studies, were included in the meta-analysis. The pooled analysis revealed a significant improvement in LVEF (standardized mean difference [SMD] = 0.43, 95% confidence interval [CI] = 0.23-0.63, p < 0.001) and exercise capacity (SMD = 0.35, 95% CI = 0.19-0.51, p < 0.001) in patients receiving stem cell therapy compared to controls. Furthermore, the meta-analysis showed a significant reduction in the composite endpoint of death, myocardial infarction, and hospitalization for heart failure (risk ratio [RR] = 0.65, 95% CI = 0.53-0.79, p < 0.001).

Subgroup analysis revealed that the benefits of stem cell therapy were more pronounced in studies that used autologous stem cells (LVEF: SMD = 0.56, 95% CI = 0.34-0.78, p < 0.001; exercise capacity: SMD = 0.43, 95% CI = 0.25-0.61, p < 0.001) and those that administered stem cells via intracoronary injection (LVEF: SMD = 0.51, 95% CI = 0.29-0.73, p < 0.001; exercise capacity: SMD = 0.39, 95% CI = 0.21-0.57, p < 0.001).

Discussion:

The findings of this systematic review and meta-analysis suggest that stem cell therapy may be a promising approach for the treatment of IHF, with significant improvements in left ventricular function, exercise capacity, and clinical outcomes. The benefits of stem cell therapy were more pronounced in studies that used autologous stem cells and those that administered stem cells via intracoronary injection. These findings are consistent with previous studies that have suggested the potential benefits of stem cell therapy in the treatment of IHF.

Limitations:

This meta-analysis was limited by the heterogeneity of the included studies, which may have been due to differences in study design, patient populations, and stem cell types used. Additionally, the quality of the evidence was generally moderate to high, with some studies having a high risk of bias.

Conclusion:

In conclusion, this systematic review and meta-analysis provide evidence that stem cell therapy may be an effective treatment for IHF, with significant improvements in left ventricular function, exercise capacity, and clinical outcomes. Further studies are needed to confirm these findings and to explore the optimal use of stem cell therapy in the treatment of IHF.

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