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Hosseinpour A, Kamalpour J, Dehdari Ebrahimi N, Mirhosseini SA, Sadeghi A, Kavousi S, Attar A. Comparative effectiveness of mesenchymal stem cell versus bone-marrow mononuclear cell transplantation in heart failure: a meta-analysis of randomized controlled trials. Stem Cell Res Ther 2024; 15:202. [PMID: 38971816 PMCID: PMC11227704 DOI: 10.1186/s13287-024-03829-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND There is no clear evidence on the comparative effectiveness of bone-marrow mononuclear cell (BMMNC) vs. mesenchymal stromal cell (MSC) stem cell therapy in patients with chronic heart failure (HF). METHODS Using a systematic approach, eligible randomized controlled trials (RCTs) of stem cell therapy (BMMNCs or MSCs) in patients with HF were retrieved to perform a meta-analysis on clinical outcomes (major adverse cardiovascular events (MACE), hospitalization for HF, and mortality) and echocardiographic indices (including left ventricular ejection fraction (LVEF)) were performed using the random-effects model. A risk ratio (RR) or mean difference (MD) with corresponding 95% confidence interval (CI) were pooled based on the type of the outcome and subgroup analysis was performed to evaluate the potential differences between the types of cells. RESULTS The analysis included a total of 36 RCTs (1549 HF patients receiving stem cells and 1252 patients in the control group). Transplantation of both types of cells in patients with HF resulted in a significant improvement in LVEF (BMMNCs: MD (95% CI) = 3.05 (1.11; 4.99) and MSCs: MD (95% CI) = 2.82 (1.19; 4.45), between-subgroup p = 0.86). Stem cell therapy did not lead to a significant change in the risk of MACE (MD (95% CI) = 0.83 (0.67; 1.06), BMMNCs: RR (95% CI) = 0.59 (0.31; 1.13) and MSCs: RR (95% CI) = 0.91 (0.70; 1.19), between-subgroup p = 0.12). There was a marginally decreased risk of all-cause death (MD (95% CI) = 0.82 (0.68; 0.99)) and rehospitalization (MD (95% CI) = 0.77 (0.61; 0.98)) with no difference among the cell types (p > 0.05). CONCLUSION Both types of stem cells are effective in improving LVEF in patients with heart failure without any noticeable difference between the cells. Transplantation of the stem cells could not decrease the risk of major adverse cardiovascular events compared with controls. Future trials should primarily focus on the impact of stem cell transplantation on clinical outcomes of HF patients to verify or refute the findings of this study.
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Affiliation(s)
- Alireza Hosseinpour
- Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jahangir Kamalpour
- Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Alireza Sadeghi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahin Kavousi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Shang X, Liu M, Zhong Y, Wang X, Chen S, Fu X, Sun M, Li G, Xie M, Song G, Zhu D, Zhang C, Dong N. Short-term study of atrial shunt and improvement of functional mitral regurgitation. J Cardiothorac Surg 2023; 18:332. [PMID: 37968674 PMCID: PMC10648378 DOI: 10.1186/s13019-023-02398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND This study used an atrial septal shunt to compare the treatment progress and prognosis for patients with heart failure (HF) who have different ejection fractions. METHODS Twenty HF patients with pulmonary hypertension, who required atrial septal shunt therapy, were included in this study. The patients underwent surgery between December 2012 and December 2020. They were divided into two groups based on their ejection fraction: a group with reduced ejection fraction (HFrEF) and a group with preserved ejection fraction(HFpEF) + mid-range ejection fraction (HfmrEF). Echocardiography was utilized to evaluate parameters such as left ventricular dimension (LVD), left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume (LVEDV). Hemodynamic parameters were measured using cardiac catheterization. The patient's cardiac function was assessed using the six-minute walking test (6MWT), KCCQ score, NYHA classification, and the degree of functional mitral regurgitation (FMR). Followed-up visits were conducted at 1, 3, and 6 months, and any adverse effects were recorded. RESULTS The LVEF values were consistently higher in the HFpEF+HFmrEF group than HFrEF group at all periods (P < 0.05). Differences in LVD were observed between the two groups before the surgery. Statistically, significant differences were found at the preoperative stage, 1 month, and 3 months (P < 0.05, respectively). However, the LVEDV showed a significant difference between the two groups only at 3 months (P = 0.049). Notably, there were notable variations in LAPm, LAPs, and the pressure gradient between the LA-RA gradient at baeline, after implantation, and during the 6 months follow-up (all P < 0.05). CONCLUSION Following treatment, the HFpEF+HFmrEF group exhibited more significant improvements in echocardiographic and cardiac catheterization indices than the HFrEF group. However, there was no statistically significant difference between the two groups regarding the 6MWT and KCCQ scores. It is important to note that the findings of this study still require further investigation in a large sample size of patients.
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Affiliation(s)
- Xiaoke Shang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Jianghan District, Wuhan, 430022, Hubei Province, China
| | - Mei Liu
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hospital Infection Office, Wuhan No.1 Hospital, Wuhan, China
| | - Yucheng Zhong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Jianghan District, Wuhan, 430022, Hubei Province, China
| | - Xueli Wang
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Chen
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojuan Fu
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Sun
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Geng Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Jianghan District, Wuhan, 430022, Hubei Province, China
| | - Mingxing Xie
- Department of Ultrasound Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangyuan Song
- Heart Valve Disease Intervention Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Da Zhu
- Structural Heart Disease Center, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Changdong Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Jianghan District, Wuhan, 430022, Hubei Province, China.
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Jianghan District, Wuhan, 430022, Hubei Province, China.
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Bhandari S, Yadav V, Ishaq A, Sanipini S, Ekhator C, Khleif R, Beheshtaein A, Jhajj LK, Khan AW, Al Khalifa A, Naseem MA, Bellegarde SB, Nadeem MA. Trends and Challenges in the Development of 3D-Printed Heart Valves and Other Cardiac Implants: A Review of Current Advances. Cureus 2023; 15:e43204. [PMID: 37565179 PMCID: PMC10411854 DOI: 10.7759/cureus.43204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/12/2023] Open
Abstract
This article provides a comprehensive review of the current trends and challenges in the development of 3D-printed heart valves and other cardiac implants. By providing personalized solutions and pushing the limits of regenerative medicine, 3D printing technology has revolutionized the field of cardiac healthcare. The use of several organic and synthetic polymers in 3D printing heart valves is explored in this article, with emphasis on both their benefits and drawbacks. In cardiac tissue engineering, stem cells are essential, and their potential to lessen immunological rejection and thrombogenic consequences is highlighted. In the clinical applications section, the article emphasizes the importance of 3D printing in preoperative planning. Surgery results are enhanced when surgeons can visualize and assess the size and placement of implants using patient-specific anatomical models. Customized implants that are designed to match the anatomy of a particular patient reduce the likelihood of complications and enhance postoperative results. The development of physiologically active cardiac implants, made possible by 3D bioprinting, shows promise by eliminating the need for artificial valves. In conclusion, this paper highlights cutting-edge research and the promise of 3D-printed cardiac implants to improve patient outcomes and revolutionize cardiac treatment.
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Affiliation(s)
| | - Vikas Yadav
- Internal Medicine, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, IND
| | - Aqsa Ishaq
- Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | | | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Rafeef Khleif
- Medicine, Xavier University School of Medicine, Aruba, ABW
| | - Alee Beheshtaein
- Internal Medicine, Xavier University School of Medicine, Chicago, USA
| | - Loveleen K Jhajj
- Internal Medicine, Xavier University School of Medicine, Oranjestad, ABW
| | | | - Ahmed Al Khalifa
- Medicine, College of Medicine, Sulaiman Alrajhi University, Al Bukayriyah, SAU
| | | | - Sophia B Bellegarde
- Pathology and Laboratory Medicine, American University of Antigua, St. John's, ATG
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Septal myocardial scar burden predicts the response to cardiac contractility modulation in patients with heart failure. Sci Rep 2022; 12:20504. [PMID: 36443407 PMCID: PMC9705404 DOI: 10.1038/s41598-022-24461-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
We hypothesized that myocardial septal scarring, assessed by cardiac magnetic resonance (CMR) using late gadolinium enhancement (LGE), at the site of cardiac contractility modulation (CCM) lead placement may predict treatment response. Eligible heart failure (HF) patients underwent LGE CMR imaging before CCM device implantation. The response to CCM therapy at follow-up was determined by a change in NYHA class and echocardiographic left ventricular ejection fraction (LVEF) assessment. Patients were classified as responders, if they showed an improvement in either NYHA class or improvement of LVEF by ≥ 5%. 58 patients were included. 67% of patients were classified as responders according to improved NYHA; 55% according to LVEF improvement. 74% of patients were responders if either NYHA class or LVEF improvement was observed. 90% of responders (according to NYHA class) showed septal LGE < 25% at septal position of the leads, while 44% of non-responders showed septal LGE > 25% (p < 0.01). In patients treated with CCM, an improvement of NYHA class was observed when leads were placed at myocardial segments with a CMR- LGE burden less than 25%.
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Ye WN, Thipse M, Mahdi MB, Azad S, Davies R, Ruel M, Silver MA, Hakami L, Mesana T, Leenen F, Mussivand T. Can heat therapy help patients with heart failure? Artif Organs 2020; 44:680-692. [PMID: 32017138 DOI: 10.1111/aor.13659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/16/2019] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
To review and analyze the clinical outcomes of thermal therapy (≤1.4°C increase in core body temperature) in patients with heart failure (HF). A systematic review and meta-analysis regarding the effects of thermal therapy on HF was done by searching PubMed, Ovid Medline, Ovid Embase, Scopus, and internal databases up to date (2019). Improvement in the New York Heart Association (NYHA) class: Ten studies with 310 patients showed significant improvement in NYHA class. Only 7 among 40 patients remained in Class IV and 99 patients in Class III from 155 patients. Increased patients in lower classes indicate that more patients showed improvement. Sixteen studies on 506 patients showed an overall improvement of 4.4% of left ventricular ejection fraction (LVEF). Four studies reported improved endothelial dysfunction by 1.7% increase in flow-mediated dilation (FMD) on 130 patients. Reduction in blood pressure: Thermal therapy reduced both systolic blood pressure (SBP) and diastolic blood pressure by 3.1% and 5.31%, respectively, in 431 patients of 15 studies. Decrease in cardiothoracic ratio (CTR): Eight studies reported an average of 5.55% reduction of CTR in a total of 347 patients. Improvement in oxidative stress markers: Plasma brain natriuretic peptide (BNP) levels significantly decreased (mean difference of 14.8 pg/dL) in 303 patients of 9 studies. Improvement of quality of life: Among 65 patients, thermal therapy reduced cardiac death and rehospitalization by 31.3%. A slight increase in core body temperature is a promising, noninvasive, effective, and complementary therapy for patients with HF. Further clinical studies are recommended.
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Affiliation(s)
- Winnie N Ye
- Department of Electronics, Carleton University, Ottawa, ON, Canada
| | - Madhura Thipse
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Maleka Ben Mahdi
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sharlin Azad
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ross Davies
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marc Ruel
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marc A Silver
- Heart Failure Institute, Advocate Christ Medical Centre, Oak Lawn, IL, USA
| | - Lale Hakami
- Medical Center, University of Munich, Munich, Germany
| | - Thierry Mesana
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Frans Leenen
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Tofy Mussivand
- Cardiovascular Devices Division, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Vo J, Chang TC, Shea KI, Myers M, Arbabian A, Vasudevan S. Assessment of miniaturized ultrasound-powered implants: an in vivo study. J Neural Eng 2020; 17:016072. [DOI: 10.1088/1741-2552/ab6fc2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Wu T, Khir AW, Kütting M, Du X, Lin H, Zhu Y, Hsu PL. A review of implantable pulsatile blood pumps: Engineering perspectives. Int J Artif Organs 2020; 43:559-569. [PMID: 32037940 DOI: 10.1177/0391398820902470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It has been reported that long-term use of continuous-flow mechanical circulatory support devices (CF-MCSDs) may induce complications associated with diminished pulsatility. Pulsatile-flow mechanical circulatory support devices (PF-MCSDs) have the potential of overcoming these shortcomings with the advance of technology. In order to promote in-depth understanding of PF-MCSD technology and thus encourage future mechanical circulatory support device innovations, engineering perspectives of PF-MCSD systems, including mechanical designs, drive mechanisms, working principles, and implantation strategies, are reviewed in this article. Some emerging designs of PF-MCSDs are introduced, and possible elements for next-generation PF-MCSDs are identified.
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Affiliation(s)
- Tingting Wu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Ashraf W Khir
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK
| | | | - Xinli Du
- Brunel Institute for Bioengineering, Brunel University London, Uxbridge, UK
| | - Hao Lin
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Yuxin Zhu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
| | - Po-Lin Hsu
- Artificial Organ Technology Laboratory, Biomanufacturing Centre, School of Mechanical and Electrical Engineering, Soochow University, Suzhou, China
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