ReviewIntramyocardial autologous bone marrow cell transplantation for ischemic heart disease: A systematic review and meta-analysis of randomized controlled trials

- Intramyocardial bone marrow cell injection contributes to improvement in left ventricular systolic dysfunction.
- Intramyocardial transplantation of bone marrow cells is effective in improving myocardial remodeling.
- The cell therapy seems to be more efficacious in patients with revascularizable IHD than in no-option patients.

ObjectiveThis study was undertaken to evaluate the efficacy of intramyocardial bone marrow cell (BMC) transplant therapy for ischemic heart disease (IHD).MethodsThe PubMed, Embase, and Cochrane Library databases through October 2013 were searched for randomized clinical trials (RCTs) of intramyocardial BMCs to treat IHD. The primary endpoint was change in left ventricular ejection fraction (LVEF). Secondary endpoints were changes in left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV). Weighted mean differences for the changes were estimated with a random-effects model.ResultsEleven RCTs with 492 participants were included. Intramyocardial BMC transplantation increased LVEF (4.91%; 95% confidence interval [CI] 2.84%-6.99%; P < 0.00001), reduced LVESV (10.66 mL; 95% CI, −18.92 mL to −2.41 mL; P = 0.01), and showed a trend toward decreased LVEDV (−7.82 mL; 95% CI, −16.36 mL-0.71 mL; P = 0.07). Patients suitable for revascularization with coronary artery bypass grafting had greater improvement in LVEF (7.60%; 95% CI, 4.74%-10.46%, P < 0.00001) than those unsuitable for revascularization (3.76%; 95% CI, 2.20%-5.32%; P < 0.00001). LVEDV reduction was also more significant in revascularizable IHD (−16.51 mL; 95% CI, −22.05 mL to −10.07 mL; P < 0.00001) than non-revascularizable IHD (−0.89 mL; 95% CI, −8.44 mL-6.66 mL; P = 0.82).ConclusionIntramyocardial BMC injection contributes to improvement in left ventricular dysfunction and reduction in left ventricular volume. Patients with revascularizable IHD may benefit more from this therapy.