Extracorporeal cardiac shock wave stimulation enhances the therapeutic efficacy of intravenously delivered endothelial colony-forming cells via PI3K/AKT signaling in a rat myocardial infarction model

• ECSW preconditioning enhances ECFC function in vitro, including migration, tube formation, proliferation, and VEGF-A secretion, while reducing apoptosis, via PI3K/AKT activation. • Intravenous delivery of SW-ECFCs significantly improves cardiac function, reduces infarct size and fibrosis, and enhances angiogenesis in a rat MI model. • The therapeutic benefits of SW-ECFCs are mediated through PI3K/AKT signaling, as inhibition with LY294002 abolishes these effects. • ECSW preconditioning represents a clinically applicable strategy to enhance stem cell therapy for myocardial infarction.