ORIGINAL ARTICLES

Heart failure and cardiomyopathy

Effect of intramyocardial bone marrow cell injection on left ventricular dyssynchrony and global strain

J van Ramshorst, D E Atsma, S L M A Beeres, S A Mollema, N Ajmone Marsan, E R Holman, E E van der Wall, M J Schalij, J J Bax

Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands

Dr J J Bax, Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; j.j.bax{at}lumc.nl

Objective: To evaluate the effect of bone marrow cell injection on global strain and left ventricular (LV) dyssynchrony.

Methods: In 14 patients with severe postinfarction heart failure, 93 (14)x10⁶ autologous bone marrow cells were percutaneously injected in the infarction border zone. LV ejection fraction (LVEF), LV dyssynchrony and echocardiographic global strain were assessed at baseline and 3 months in patients and in a non-randomised control group of 10 patients with a history of infarction who developed heart failure and were treated medically.

Results: No periprocedural complications occurred during bone marrow cell injection. At 3 months mean (SD) LVEF increased from 23 (8)% to 27 (9)% (p = 0.02) and global strain improved from –7.7 (4.7)% to –8.5 (4.9)% (p = 0.04). In patients with 5% improvement in LVEF after bone marrow cell injection, global strain improved from –8.7 (4.6)% to –10.6 (4.5)% (p<0.01). Global strain remained unchanged in patients with <5% improvement in LVEF (–6.6 (4.9)% vs –6.4 (4.5)%, p = NS). The relation between the increase in LVEF and improvement in global strain was significant (r = 0.84, p<0.01). In patients with 5% improvement in LVEF, LV dyssynchrony decreased from 173 (64) ms to 116 (64) ms (p = 0.01). In patients with <5% improvement in LVEF, LV dyssynchrony remained unchanged (155 (67) ms vs 177 (81) ms, p = NS). The correlation between improvement in LVEF and reduction in LV dyssynchrony was good (r = –0.77, p<0.01). In the control group, LVEF, global strain and LV dyssynchrony did not improve.

Conclusions: Bone marrow cell injection improves LVEF in patients with severe postinfarction heart failure. The improvement in LVEF was related to reduced LV dyssynchrony and increased global strain.

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Relevant Article

Bone marrow cells to improve ventricular function

Bodo-Eckehard Strauer, Gudrun Ott, Christine Maria Schannwell, and Michael Brehm
Heart 2009 95: 98-99. [Extract] [Full Text] [PDF]

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