Heart failure remains one of the leading causes of disability among adults worldwide. Although modern cardiology has significantly improved survival rates through medications and interventional procedures, many patients continue to experience progressive fatigue, exercise intolerance, reduced cardiac function, and impaired quality of life.

In recent years, regenerative medicine has emerged as a promising field aimed at supporting tissue repair, improving cellular metabolism, and restoring biological function in patients with chronic cardiac conditions. Observe new Treatment Protocol of Cardio Disease with Stem Cells: Stem Cells Treatment for Heart Failure and Cardiomyopathy

This clinical case describes the experience of Dr. Bitten Tryse, a retired gynecologist from Norway, who developed chronic cardiomyopathy and heart failure following suspected myocarditis and later underwent a personalized regenerative medicine program utilizing multiple cellular technologies.

Patient Background

Patient: Dr. Bitten Tryse

Age at Treatment: 64 years

Nationality: Norwegian

Medical Profession: Gynecologist (Retired)

Primary Diagnosis:

• Chronic Heart Failure
• Dilated Cardiomyopathy
• Reduced Left Ventricular Ejection Fraction
• History of Ventricular Tachycardia
• Previous Myocarditis (suspected viral etiology)

Notably, the patient reported no family history of cardiac disease and had been healthy before the onset of symptoms.

 

Initial Disease Development

In 2012, while residing part-time in Portugal, the patient began experiencing episodes of ventricular tachycardia (VT).

Comprehensive cardiological assessment revealed:

• Scattered myocardial scarring within the lateral left ventricular wall
• Additional septal scarring
• Left ventricular ejection fraction (EF) approximately 52%
• Mild mitral regurgitation
• Normal coronary arteries on angiography

At that time, myocarditis was considered the most likely underlying diagnosis.

Arrhythmia Management

Between 2014 and 2018, the patient underwent two successful ventricular ablation procedures performed by Professor Karl-Heinz Kuck in Hamburg, Germany.

Following these interventions:

• Ventricular arrhythmias resolved
• Rhythm stability improved
• No recurrent ventricular tachycardia episodes were reported

Progression to Heart Failure

Despite successful arrhythmia control, progressive cardiac dysfunction developed.

By 2018:

• Ejection fraction decreased to 30–35%
• Clinical heart failure symptoms appeared
• Entresto and diuretics were initiated

During treatment, severe hypokalemia developed (Potassium 2.6 mmol/L), resulting in ventricular fibrillation.

Fortunately, the patient recovered completely following emergency management and subsequent optimization of therapy with:

• Candesartan
• Metoprolol
• Spironolactone

Cardiac function partially recovered:

EF improved to approximately 45–48%.

Follow-Up Cardiology Assessment (2024)

Cardiology Outpatient Clinic
Oslo University Hospital

Clinical Findings

• Blood Pressure: 118 mmHg
• Pulse: 65 bpm
• No peripheral edema
• Normal heart and lung auscultation

ECG

• Sinus Rhythm
• Narrow QRS Complex
• Left Anterior Hemiblock
• Evidence of prior anterior wall injury

Laboratory Results

Parameter	Result
Hemoglobin	14.1
Leukocytes	10.8
ESR	16
INR	1.0
Creatinine	90
Troponin T	9
HbA1c	38
CRP	1.2
TSH	2.8
NT-proBNP	1957

Echocardiography

• Mildly dilated left ventricle
• EF 33%
• Moderate mitral regurgitation
• Moderate tricuspid regurgitation
• Dilated right ventricle with preserved function
• No pericardial effusion

Final Diagnosis

Chronic Heart Failure of Unknown Etiology

Likely post-inflammatory cardiomyopathy following previous myocarditis.

Why Regenerative Therapy Was Considered

Although guideline-directed medical therapy had stabilized the patient’s condition, persistent systolic dysfunction remained.

Major concerns included:

• Reduced ejection fraction
• Progressive myocardial remodeling
• Persistent exercise limitation
• Elevated NT-proBNP
• Ongoing cardiac cellular dysfunction

A personalized regenerative medicine strategy was therefore developed to target multiple biological mechanisms simultaneously.

Personalized Cell Therapy Protocol

Unlike conventional approaches focusing on a single cell type, a multimodal regenerative strategy was selected.

Cardiomyocyte Progenitor Cells

Cardiomyocyte progenitors were utilized to support myocardial repair mechanisms and promote regeneration of damaged cardiac tissue.

Potential regenerative targets included:

• Cellular turnover support
• Contractile tissue recovery
• Improved myocardial signaling

Endothelial Cell Therapy

Endothelial dysfunction plays a central role in chronic heart failure.

Endothelial cell support was incorporated to potentially improve:

• Microvascular circulation
• Oxygen delivery
• Capillary integrity
• Tissue perfusion

Epithelial-Regenerative Cell Components

Specialized epithelial-supportive cellular factors were included to enhance tissue communication and regenerative signaling pathways.

Their role focused on:

• Cellular protection
• Structural tissue support
• Regenerative microenvironment modulation

Mesenchymal Stem Cells (MSCs)

Mesenchymal stem cells were included for their well-known:

• Anti-inflammatory activity
• Immunomodulatory effects
• Paracrine signaling properties
• Tissue repair support

MSCs may contribute to reducing chronic inflammatory processes that persist following myocarditis and viral injury.

Mitochondrial Therapy

Cardiac muscle is among the most energy-demanding tissues in the human body.

Mitochondrial support was incorporated to address:

• Cellular energy production
• ATP generation
• Oxidative stress
• Metabolic efficiency

Improved mitochondrial function may help enhance myocardial performance and exercise capacity. Read more about Mitochondria Role :Mitochondrial Dysfunction: The Hidden Driver Behind Chronic Disease and Healthy Aging

Biological Objectives of Treatment

The treatment strategy aimed to address five major therapeutic targets:

1. Cardiac tissue regeneration
2. Improvement of myocardial metabolism
3. Reduction of chronic inflammation
4. Enhancement of microcirculation
5. Optimization of cellular energy production

Reported Functional Improvements After Therapy

Parameters	Before	After
Hemoglobin	14.1	14.3
Leukocytes	10.8	7.2
ESR	16	8
INR	1.0	1.0
Creatinine	90	82
Troponin T	9	5
HbA1c	38	37
CRP	1.2	0.4
TSH	2.8	2.5
NT-proBNP	1957	420

Echocardiography (after therapy)

• Left ventricle: normal size or only minimally dilated
• Left ventricular ejection fraction (EF): 52%
• Mild mitral regurgitation
• Mild tricuspid regurgitation
• Right ventricle: normal size and preserved function
• No pericardial effusion
• No significant pulmonary hypertension

Summary of improvement

• EF increased from 33% → 52%
• NT-proBNP decreased from 1957 → 420 pg/mL
• Reduction of ventricular dilatation
• Mitral and tricuspid regurgitation improved from moderate to mild
• Inflammatory markers (ESR, CRP) normalized
• Renal function remained stable
• No evidence of ongoing myocardial injury (lower troponin)

During follow-up, the patient reported substantial improvements in daily physical function and quality of life.

Observed improvements included:

Increased Exercise Capacity

Prior to therapy:

• Limited physical endurance
• Reduced exercise tolerance
• Fatigue during prolonged activity

After therapy:

• Significant increase in walking distance
• Improved stamina
• Better recovery after exertion

Mountain Hiking

One of the most meaningful functional milestones reported by the patient was a return to mountain hiking activities.

This level of physical activity had previously become difficult due to fatigue and cardiac limitations.

Horse Riding

The patient also resumed horseback riding, an activity requiring:

• Cardiovascular endurance
• Balance
• Physical strength
• Sustained energy production

Improved Daily Quality of Life

Reported benefits included:

• Greater vitality
• Improved confidence during physical activity
• Reduced perception of cardiac limitation
• Enhanced overall well-being

Clinical Comparison: Before and After Therapy

Parameter	Before Therapy	After Therapy*
Exercise Tolerance	Reduced	Significantly Improved
Daily Energy	Low	Improved
Mountain Hiking	Limited	Resumed
Horse Riding	Difficult	Resumed
Fatigue	Frequent	Reduced
Physical Endurance	Limited	Improved
Quality of Life	Impaired	Markedly Improved

*Based on patient-reported outcomes and follow-up clinical observations.

Why a Multi-Cellular Approach May Be Important

Heart failure is rarely caused by a single biological mechanism.

Following myocarditis and viral injury, multiple pathological processes may coexist:

• Scar formation
• Cellular dysfunction
• Endothelial damage
• Mitochondrial impairment
• Chronic inflammation
• Microvascular abnormalities

For this reason, targeting only one mechanism may provide limited benefit.

A multimodal regenerative strategy seeks to address several biological pathways simultaneously.

The Emerging Role of Regenerative Cardiology

Modern regenerative cardiology is increasingly exploring:

• Cardiomyocyte regeneration
• Endothelial restoration
• Stem cell-derived signaling molecules
• Exosome therapies
• Mitochondrial medicine
• Personalized cellular combinations

Although further clinical research is necessary, these approaches represent an evolving frontier in cardiovascular medicine.

Conclusion

This case illustrates the potential role of personalized regenerative medicine in a patient with chronic heart failure following suspected myocarditis. By combining cardiomyocyte progenitors, mesenchymal stem cells, endothelial-supportive therapies, epithelial regenerative components, and mitochondrial support, the treatment strategy aimed to address the complex biological mechanisms underlying cardiac dysfunction.

Following therapy, the patient reported meaningful improvements in physical performance, exercise capacity, and overall quality of life, including the ability to return to mountain hiking and horseback riding.

While larger controlled clinical studies remain necessary to further define outcomes and long-term benefits, this case highlights the growing potential of regenerative cardiology as a complementary approach for carefully selected patients with chronic cardiac disease.