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 via PI3K/AKT pathway activation, improving migration, tube formation, proliferation, and VEGF-A secretion while reducing apoptosis. • Intravenous delivery of SW-ECFCs significantly improves cardiac function and reduces infarct size in a rat MI model, outperforming non-preconditioned ECFCs. • The therapeutic benefits of SW-ECFCs are mediated by PI3K/AKT signaling, as inhibition with LY294002 abolishes the enhanced effects. • This study provides a novel preconditioning strategy to overcome the low engraftment and poor survival of transplanted ECFCs, offering a promising approach for stem cell-based cardiac repair.