Advanced Therapeutic Strategies for Ischemic Heart Failure

Abstract

Survival after heart failure diagnosis is low, with survival at 1, 2, and 5 years of 90%, 80%, and 60% respectively. Novel and improved treatment options for heart failure are needed. This thesis covers advanced therapeutic strategies for ischemic heart failure, which comprise cell therapy, regenerative strategies, and advancements in pacemaker implantation. Cell therapy emerged as a promising treatment strategy for heart failure patients in the early 2000s. However, it quickly became apparent that stem cells did not develop into heart cells. Effects of cell transplantation on heart function are seen, but are moderate and can be contributed to certain factors that the transplanted cells excrete. In this thesis, we compared different cell types to determine which type is the most effective. Furthermore, we compared different transplantation strategies in search of improved cell delivery to the heart. Beside cell therapy, we provide on overview of literature on the protein FSTL1. Certain beneficial properties have been attributed to this protein. One of these is the ability of FSTL1 to make native heart cells divide again, and in this way regrow lost heart tissue after an infarct. The final part of this thesis focusses on improved pacemaker implantation. After an infarct, cardiac tissue is lost, and the heart has difficulty to contract in a normal and synchronous way. Certain types of pacemakers can make the damaged heart contract more symmetrically, and thus, more effective. We tried to identify the optimal pacing site before pacemaker implantation using magnetic resonance imaging.