Direct autologous bone marrow-derived stem cell transplantation for ischemic heart disease: a meta-analysis.

摘要

OBJECTIVE: Previous evaluation of intracoronary autologous bone marrow-derived stem cell (BMSCs) therapy following ischemic heart disease (IHD) suggested improvement of cardiac functional parameters. We performed a meta-analysis to provide systematic assessment of the safety and efficacy of direct (intramyocardial or endomyocardial) BMSCs transplantation in patients with IHD. RESEARCH DESIGN AND METHODS: Randomized controlled Trials (RCTs) were identified in the MEDLINE (approximately Oct. 2010), the Cochrane Central Register of Controlled Trials (Central) (approximately Oct. 2010), EMBASE (approximately Oct. 2010), and EBSCO (approximately Oct. 2010), reviews, and reference lists of relevant articles. Weighted mean difference (WMD) was calculated for changes in left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV) by using a fixed effects model. RESULTS: Eight RCTs with 307 participants were eligible. Compared with controls, direct BMSCs transplantation improved LVEF (8.4%, 95% CI, 6.49 to 10.31%; p < 0.01), reduced LVESV and LVEDV (-14.85 ml, 95% CI, -27.29 to -2.41 ml, p = 0.02 and -12.79 ml, 95% CI, -24.94 to -0.65 ml, p = 0.04, respectively). CONCLUSIONS: This meta-analysis suggests that direct BMSCs transplantation is associated with moderate but significant improvements over regular therapy in cardiac functional parameters in patients with IHD, and supports conducting further RCTs of a higher quality.