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Heart failure and cardiomyopathy
Effect of intramyocardial bone marrow cell injection on left ventricular dyssynchrony and global strain
  1. J van Ramshorst,
  2. D E Atsma,
  3. S L M A Beeres,
  4. S A Mollema,
  5. N Ajmone Marsan,
  6. E R Holman,
  7. E E van der Wall,
  8. M J Schalij,
  9. J J Bax
  1. Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
  1. Dr J J Bax, Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; j.j.bax{at}lumc.nl

Abstract

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)×106 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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Footnotes

  • See Editorial, p 98

  • Competing interests: Declared. NAM is financially supported by an unrestricted grant from GE Healthcare (Milwaukee, Wisconsin, USA). JJB has a research grant from GE Healthcare (Milwaukee, Wisconsin, USA).

  • Ethics approval: Approved by the local ethics committee.

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