Cardiac performance after myocardial infarction (MI) is compromised by ventricular remodeling, which represents a major cause of late infarct-related chronic heart failure and death. Clinical studies have shown recently that bone marrow mononuclear cells (BMCs) may restore damaged myocardium in humans (1,2) with variable certainty (3,4). Stem cells have the important properties of self-regeneration and differentiational plasticity. Human bone marrow contains CD34 positive haematopoietic and CD34 negative mesenchymal stem cells and both these types of stem cells may contribute to heart muscle repair. Clinical studies with direct intracoronary transplantation of bone marrow cells until now are concerned preferably with three clinically relevant situations: - therapy for acute myocardial infarction (1–4, 11, 12) - therapy for old myocardial infarction (≥8 years, with heart failure) (5) - therapy for congestive heart failure (dilatative cardiomyopathy) (6,12) The study in this issue by Ramshorst et al. (7) focusses important aspects of bone marrow cell-related therapy in chronic heart dysfunction: (i) the route of cell delivery, (ii) the relationship between improved LV function and synchronicity of wall motion in chronic infarction and (iii) the possible mechanism of bone marrow cell action in heart failure.
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