Imaging in Stem Cell Transplant and Cell-based Therapy

145

9.6 Conclusions

Cell therapy represents a highly promising approach for effective cardiac repair in
patients with ischemic heart disease and cardiomyopathy. Although results from
smaller clinical trials of BMC therapy have been disparate, evidence from a large
number of meta-analyses suggests that BMC-treated IHD patients experience mod-
est yet significant improvements in cardiac structure and function compared with
patients receiving standard treatments. Although diverse imaging modalities have
been used to measure specific LV parameters, meta-analysis of pooled data reveals
directionally concordant results with different techniques. However, the selection of
a specific imaging technique for a particular clinical trial depends on other factors
besides accuracy. These include the availability of imaging equipment, cost, and
patient characteristics. Moreover, the efficacy of BMC therapy for cardiac repair is
also supported by imaging-independent parameters, such as improved clinical out-
comes, including survival. Future large RCTs will likely provide definitive answers
in this controversial yet critically important field.

References

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Table 9.4 Clinical outcomes in bone marrow cell-treated patients compared with patients
receiving standard therapy

Outcome BMC therapy (n) Control (n) Peto OR [95% CI] P Value

All-cause mortality 1397 980 0.55 [0.34–0.89] 0.01

Cardiac deaths 970 666 0.52 [0.24–1.13] 0.10

Recurrent MI 1159 799 0.50 [0.27–0.92] 0.03

Heart failure 1027 761 0.62 [0.37–1.05] 0.08

Stent thrombosis 599 458 0.48 [0.21–1.09] 0.08

In-stent restenosis 432 332 0.92 [0.55–1.54] 0.75

TVR 866 606 0.84 [0.59–1.21] 0.36

C VA 640 462 0.25 [0.08–0.81] 0.02

VT/VF 481 419 0.45 [0.22–0.93] 0.03

Modified and reproduced from Afzal et al. Circ Res 2015;117:558–575 with permission
BMC bone marrow cell, CVA cerebrovascular accident, MI myocardial infarction, OR odds ratio,
TVR target vessel revascularization, VF ventricular fibrillation, VT ventricular tachycardia, CI con-
fidence interval, n number of patients in each group

9 Bone Marrow Cell Therapy for Ischemic Heart Disease...