IMPACT OF STEM CELL THERAPY ADDED TO GUIDELINE-DIRECTED MEDICAL THERAPY ON QUALITY OF LIFE IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY.

BACKGROUND: Despite substantial advances in guideline-directed medical therapy (GDMT), many patients with ischemic cardiomyopathy (ICM) and heart failure with reduced ejection fraction (HFrEF) continue to experience persistent symptoms and impaired quality of life. Regenerative cell therapy has emerged as a promising adjunctive treatment; however, its clinical effectiveness remains under active investigation. AIM: To evaluate the association between adjunctive autologous bone marrow-derived mononuclear stem cell therapy and quality of life in patients with ischemic cardiomyopathy receiving contemporary guideline-directed medical therapy. MATERIALS AND METHODS: This prospective non-randomized controlled study included 54 patients with ischemic cardiomyopathy and HFrEF (left ventricular ejection fraction ≤40%). Twenty-seven patients underwent autologous bone marrow-derived mononuclear stem cell transplantation in addition to optimized GDMT, while 27 patients received optimized GDMT alone. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at baseline and after 12 months. Within-group comparisons were performed using the Wilcoxon signed-rank test, and between-group comparisons using the Mann-Whitney U test. RESULTS: After 12 months, patients receiving adjunctive stem cell therapy demonstrated significantly greater improvement in overall MLHFQ score than patients treated with optimized GDMT alone. Significant improvements were also observed across several MLHFQ domains, particularly those related to physical functioning, mobility, daytime fatigue, daily activities, sexual activity, and memory and concentration. These benefits were observed in patients receiving optimized contemporary GDMT, including widespread use of angiotensin receptor-neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors. CONCLUSION: Adjunctive autologous bone marrow-derived mononuclear stem cell therapy was associated with greater improvement in quality of life than optimized guideline-directed medical therapy alone in patients with ischemic cardiomyopathy and HFrEF. These findings suggest that regenerative cell therapy may provide additional patient-reported benefits when added to contemporary pharmacological treatment. However, because of the prospective non-randomized design, relatively small sample size, and single-center setting, the results should be interpreted with appropriate caution and require confirmation in larger multicenter randomized controlled trials.