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Intramyocardial Cell Delivery: Observations in Murine Hearts
Published on: January 24, 2014
Effect of intramyocardial bone marrow cell injection on left ventricular dyssynchrony and global strain
J van Ramshorst1, D E Atsma, S L M A Beeres
1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Insights
Bone marrow cell injection improved heart function in severe heart failure patients. This treatment reduced left ventricular (LV) dyssynchrony and increased global strain, leading to better ejection fraction.
Area of Science:
- Cardiology
- Regenerative Medicine
- Biomedical Engineering
Background:
- Severe postinfarction heart failure significantly impairs left ventricular (LV) function.
- LV dyssynchrony and reduced global strain are key indicators of impaired cardiac mechanics.
Purpose of the Study:
- To assess the impact of autologous bone marrow cell injection on global strain and LV dyssynchrony in patients with severe postinfarction heart failure.
- To correlate changes in LV function with improvements in cardiac mechanics.
Main Methods:
- 14 patients with severe postinfarction heart failure received percutaneous injection of autologous bone marrow cells into the infarction border zone.
- Left ventricular ejection fraction (LVEF), LV dyssynchrony, and echocardiographic global strain were measured at baseline and 3 months.
- A control group of 10 medically treated patients with similar conditions was used for comparison.
Main Results:
- Bone marrow cell injection was safe, with no periprocedural complications.
- At 3 months, mean LVEF increased significantly (23% to 27%, p=0.02) and global strain improved (-7.7% to -8.5%, p=0.04).
- Significant improvements in global strain and reductions in LV dyssynchrony were observed in patients with >=5% LVEF improvement, correlating strongly with LVEF increase (r=0.84) and dyssynchrony reduction (r=-0.77).
Conclusions:
- Autologous bone marrow cell injection is an effective therapy for improving LVEF in severe postinfarction heart failure.
- The observed LVEF improvement is mechanistically linked to reduced LV dyssynchrony and enhanced global strain.
- These findings highlight the potential of cell therapy to restore cardiac function and mechanics.
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.
