Cell Therapy for Nonischemic Cardiomyopathy
Current Status and Future Perspectives
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Currently, nonischemic dilated cardiomyopathy (NICM) represents the leading cause of advanced heart failure, accounting for >50% of all heart transplantation procedures. We propose that when compared with patients with ischemic heart failure (IHF), patients with NICM demonstrate a more favorable clinical response to cell therapy, which offers a potential novel promising treatment approach for this patient population.
Chronic heart failure represents one of the most important healthcare problems worldwide. Although survival after diagnosis of heart failure has improved, overall mortality remains high.1 In the recent years, several novel approaches for heart failure management have been tested in clinical trials, with cell therapy representing one of potentially more promising treatment modalities.
The majority of clinical trials of cell therapy in chronic heart failure have been focusing on patients with IHF. In this cohort, early trials demonstrated clinical benefits and an improvement in left ventricular function after cell therapy; however, subsequent larger trials failed to confirm these findings. Furthermore, a recent meta-analysis of 38 randomized controlled trials in IHF found only low-quality evidence that treatment with bone marrow-derived cells reduces mortality and improves left ventricular ejection fraction (LVEF).2 Although the reasons for the inconsistent results remain poorly defined, they could be partially explained by the fact that despite the potential beneficial effects on the myocardium, cell therapy does not affect the progression of atherosclerosis, which may limit the clinical efficacy of this approach in patients with IHF.
In the last decade, NICM has become the leading cause of advanced heart failure, accounting for >50% of all heart transplantations.1 These trends indicate that patients with NICM may represent the largest subpopulation of heart failure patients with a particular need for alternative treatment modalities, including cell therapy. The disease progression …