Background: The roots of Codonopsis pilosula (Franch.) Nannf. have been used in traditional Chinese medicine for treating cardiovascular disease. In the current study, we aimed to discover herbal extracts from C. pilosula that are capable of improving cardiac function of infarcted hearts to develop a potential therapeutic approach. Methods: A mouse embryonic stem (ES) cell-based model with an enhanced green fluorescent protein (eGFP) reporter driven by a cardiomyocyte-specific promoter, the α-myosin heavy chain, was constructed to evaluate the cardiogenic activity of herbal extracts. Then, herbal extracts from C. pilosula with cardiogenic activity based on an increase in eGFP expression during ES cell differentiation were further tested in a rat myocardial infarction model with left anterior descending artery (LAD) ligation. Cardiac function assessments were performed using echocardiography, 1, 3, and 6 weeks post LAD ligation. Results: The herbal extract 417W from C. pilosula was capable of enhancing cardiogenic differentiation in mouse ES cells in vitro. Echocardiography results in the LAD-ligated rat model revealed significant improvements in the infarcted hearts at least 6 weeks after 417W treatment that were determined based on left ventricle fractional shortening (FS), fractional area contraction (FAC), and ejection fraction (EF). Conclusions: The herbal extract 417W can enhance the cardiogenic differentiation of ES cells and improve the cardiac function of infarcted hearts.

For two decades now, the optimal management of acute coronary syndrome has been the early restoration of complete and sustained flow to the jeopardized infarct area. Advances in thrombolytic therapy and percutaneous coronary interventions have contributed significantly to the re-establishment of epicardial flow. However, a body of evidence now strongly indicates that restoration of epicardial flow alone is not sufficient to optimize clinical outcomes. Rather, it has become evident that reperfusion therapy must also involve restoration of microcirculatory reperfusion. Thus, techniques to assess myocardial perfusion during acute myocardial infarction are becoming increasingly relevant for the assessment of patient prognosis.