Cardiac stem cell therapy to promote engraftment of de novo beating cardiac 
muscle cells in cardiomyopathies could potentially improve clinical outcomes for 
many patients with congestive heart failure. Clinical trials carried out over 
the last decade for cardiac regeneration have revealed inadequacy of current 
approaches in cell therapy. Chief among them is the choice of stem cells to 
achieve the desired outcomes. Initial enthusiasm of adult bone marrow stems 
cells for myocyte regeneration has largely been relegated to paracrine-driven, 
donor cell-independent, endogenous cardiac repair. However, true functional 
restoration in heart failure is likely to require considerable myocyte 
replacement. In order to match stem cell application to various clinical 
scenarios, we review the necessity to preprime stem cells towards cardiac fate 
before myocardial transplantation and if these differentiated stem cells could 
confer added advantage over current choice of undifferentiated stem cells. We 
explore differentiation ability of various stem cells to cardiac 
progenitors/cardiomyocytes and compare their applicability in providing targeted 
recovery in light of current clinical challenges of cell therapy.