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BioMed Research International
Volume 2015 (2015), Article ID 613782, 7 pages
http://dx.doi.org/10.1155/2015/613782
Research Article

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

1Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy
2VCU Pauley Heart Center, Virginia Commonwealth University, 821 West Franklin Street, Richmond, VA 23284, USA
3Fondazione Eleonora Lorillard Spencer Cenci, 00185 Roma, Italy
4Heart Failure and Cardiac Rehabilitation Unit, Columbus Integrated Complex, Via Giuseppe Moscati 31, 00168 Rome, Italy
5Oxford Heart Center, Oxford University Hospital, Headley Way, Oxford OX3 9DU, UK
6Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
7Department of AngioCardioNeurology, IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy

Received 19 January 2015; Accepted 16 March 2015

Academic Editor: Christof Kolb

Copyright © 2015 Mariangela Peruzzi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 () and showed more pronounced effect estimates (). Higher citations were associated with journal impact factor (), corresponding author from North America/Europe (), and inclusion of nonrandomized trials (). Conclusions. Substantial heterogeneity is apparent among these reviews in terms of quality and effect estimates.