Risk stratification and management of sudden cardiac death: a new paradigm

Translational research of adult stem cell therapy

Congestive heart failure (CHF) secondary to chronic coronary artery disease is a major cause of morbidity and mortality world-wide. Its prevalence is increasing despite advances in medical and device therapies. Cell based therapies generating new cardiomyocytes and vessels have emerged as a promising treatment to reverse functional deterioration and prevent the progression to CHF. Functional efficacy of progenitor cells isolated from the bone marrow and the heart have been evaluated in preclinical large animal models. Furthermore, several clinical trials using autologous and allogeneic stem cells and progenitor cells have demonstrated their safety in humans yet their clinical relevance is inconclusive. This review will discuss the clinical therapeutic applications of three specific adult stem cells that have shown particularly promising regenerative effects in preclinical studies, bone marrow derived mesenchymal stem cell, heart derived cardiosphere-derived cell and cardiac stem cell. We will also discuss future therapeutic approaches.

Prävention des plötzlichen Herztodes

The problem of sudden cardiac death (SCD) is complex and many questions concerning the pathophysiologic mechanism are still unanswered. At present the only reliable way of recognizing high risk patients is by means of left ventricular dysfunction, measured as LV-EF<or=35%. The positive predictive accuracy for other non-invasive risk markers is too low. So far, antiarrhythmic drugs have failed to successfully prevent SCD. More than 25 years of clinical experience with the implantable defibrillator (ICD) with its continuous technical improvement has made the ICD the most effective weapon against SCD. Its effectiveness has been demonstrated in many prospective trials and the use of the ICD is fully enclosed within the current guidelines for the prevention of SCD. Guidelines do not, however, replace the physician's judgement and experience to correctly evaluate the patient's status. ICD therapy in the primary and secondary prevention of heart failure, which is often accompanied by a high risk of SCD is, however, not justified without guideline-adjusted therapy.