State of the Art on the Evidence Base in Cardiac Regenerative Therapy: Overview of 41 Systematic Reviews

Author:

Peruzzi Mariangela1ORCID,De Falco Elena1,Abbate Antonio2,Biondi-Zoccai Giuseppe123,Chimenti Isotta1ORCID,Lotrionte Marzia4,Benedetto Umberto5,Delewi Ronak6,Marullo Antonino G. M.1,Frati Giacomo17

Affiliation:

1. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy

2. VCU Pauley Heart Center, Virginia Commonwealth University, 821 West Franklin Street, Richmond, VA 23284, USA

3. Fondazione Eleonora Lorillard Spencer Cenci, 00185 Roma, Italy

4. Heart Failure and Cardiac Rehabilitation Unit, Columbus Integrated Complex, Via Giuseppe Moscati 31, 00168 Rome, Italy

5. Oxford Heart Center, Oxford University Hospital, Headley Way, Oxford OX3 9DU, UK

6. Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands

7. Department of AngioCardioNeurology, IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy

Abstract

Objectives. To provide a comprehensive appraisal of the evidence from secondary research on cardiac regenerative therapy.Study Design and Setting. Overview of systematic reviews of controlled clinical trials concerning stem cell administration or mobilization in patients with cardiovascular disease.Results. After a systematic database search, we short-listed 41 reviews (660 patients). Twenty-two (54%) reviews focused on acute myocardial infarction (AMI), 19 (46%) on chronic ischemic heart disease (IHD) or heart failure (HF), 29 (71%) on bone marrow-derived stem-cells (BMSC), and 36 (88%) to randomized trials only. Substantial variability among reviews was found for validity (AMSTAR score: median 9 [minimum 3]; 1st quartile 9; 3rd quartile 10; maximum 11), effect estimates (change in ejection fraction from baseline to follow-up: 3.47% [0.02%; 2.90%; 4.22%; 6.11%]), and citations (Web of Science yearly citations: 4.1 [0; 2.2; 6.5; 68.9]). No significant association was found between these three features. However, reviews focusing on BMSC therapy had higher validity scores (P=0.008) and showed more pronounced effect estimates (P=0.002). Higher citations were associated with journal impact factor (P=0.007), corresponding author from North America/Europe (P=0.022), and inclusion of nonrandomized trials (P=0.046).Conclusions. Substantial heterogeneity is apparent among these reviews in terms of quality and effect estimates.

Publisher

Hindawi Limited

Subject

General Immunology and Microbiology,General Biochemistry, Genetics and Molecular Biology,General Medicine

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