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The Effect of Intramyocardial Bone Marrow Cell Injection on Left Ventricular Dyssynchrony and Global Strain
  1. Jan van Ramshorst (j.van_ramshorst{at}lumc.nl)
  1. Leiden University Medical Center, Netherlands
    1. Douwe E Atsma (d.atsma{at}lumc.nl)
    1. Leiden University Medical Center, Netherlands
      1. Saskia LMA Beeres (s.l.m.a.beeres{at}lumc.nl)
      1. Leiden University Medical Center, Netherlands
        1. Sjoerd A Mollema (s.mollema{at}lumc.nl)
        1. Leiden University Medical Center, Netherlands
          1. Nina Ajmone Marsan (n.ajmonemarsan{at}lumc.nl)
          1. Leiden University Medical Center, Netherlands
            1. Eduard R Holman (e.holman{at}lumc.nl)
            1. Leiden University Medical Center, Netherlands
              1. Ernst E van der Wall (evanderwall{at}lumc.nl)
              1. Leiden University Medical Center, Netherlands
                1. Martin J Schalij (m.schalij{at}lumc.nl)
                1. Leiden University Medical Center, Netherlands
                  1. Jeroen J Bax (j.van_ramshorst{at}lumc.nl)
                  1. Leiden University Medical Center, Netherlands

                    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.

                    • Echocardiography
                    • Heart Failure
                    • Stem Cells

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