title: Effect of intramyocardial bone marrow cell injection on left ventricular dyssynchrony and global strain.
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) x 10(6) 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 > or =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 > or =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.
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Ramshorst
authors.forename: D E
authors.initials: DE
authors.lastname: Atsma
authors.forename: S L M A
authors.initials: SL
authors.lastname: Beeres
authors.forename: S A
authors.initials: SA
authors.lastname: Mollema
authors.forename: N
authors.initials: N
authors.lastname: Ajmone Marsan
authors.forename: E R
authors.initials: ER
authors.lastname: Holman
authors.forename: E E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: M J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods*; D004452:Echocardiography; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery*; D013318:Stroke Volume / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery*