The Effect of Intramyocardial Bone Marrow Cell Injection on Left Ventricular Dyssynchrony and Global Strain

Jan van Ramshorst ^1*, Douwe E Atsma ¹, Saskia LMA Beeres ¹, Sjoerd A Mollema ¹, Nina Ajmone Marsan ¹, Eduard R Holman ¹, Ernst E van der Wall ¹, Martin J Schalij ¹ and Jeroen J Bax ¹

¹ Leiden University Medical Center, Netherlands

^* To whom correspondence should be addressed. E-mail: j.van_ramshorst{at}lumc.nl.

Accepted 24 December 2007

Abstract

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

Methods In 15 patients with severe post-infarction heart failure, 93±18x10⁶ autologous bone marrow cells were percutaneously injected in the infarction border zone. At baseline and at 3 months, LV ejection fraction (LVEF) (Tc-99m tetrofosmin gated SPECT), LV dyssynchrony (speckle tracking analysis), and echocardiographic global strain (automated function imaging) were assessed. LVEF, LV dyssynchrony and global strain were also assessed in a non-randomized control group comprising 10 patients with history of infarction who developed heart failure and were treated medically.

Results No peri-procedural complications occurred during bone marrow cell injection. LVEF increased from 23±8% to 27±9% at 3 months (P=0.02). Global strain improved from -7.7±4.7% to -8.5±4.9% at 3 months (P=0.04). In patients with a substantial improvement (>5%) 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 without a substantial improvement in LVEF (-6.6±4.9% vs. -6.4±4.5%, P=NS). There was a significant relation between the increase in LVEF and the improvement in global strain (r=0.84, P<0.01). In patients with a substantial improvement in LVEF, LV dyssynchrony decreased from 173±64 ms to 116±64 ms (P=0.01). In patients without a substantial improvement in LVEF, LV dyssynchrony remained unchanged (155±67 ms vs. 177±81 ms, P=NS). There was an excellent correlation between the improvement in LVEF and the reduction in LV dyssynchrony (r=-0.77, P<0.01). In the control group, LVEF, global strain and LV dyssynchrony did not improve.

Conclusions In conclusion, bone marrow cell injection improves LVEF in patients with severe post-infarction heart failure. The improvement in LVEF was related to a reduced LV dyssynchrony and an increased global strain.

Keywords: Echocardiography, Heart Failure, Stem Cells

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