Key result
2D speckle tracking detects post-cell therapy contractile gains with ~30-fold greater sensitivity than standard wall motion scoring.
Why the study?
The subtle effects of transplanted bone marrow cells on regional myocardial behavior in ischemic heart disease patients are difficult to assess with standard methods.
Does 2D speckle tracking strain analysis better detect regional contractile improvements from intramyocardial bone marrow cell injection compared to standard wall motion assessment in patients with ischemic heart disease?
Does 2D speckle tracking strain analysis better detect regional contractile improvements from intramyocardial bone marrow cell injection compared to standard wall motion assessment in patients with ischemic heart disease?
2D speckle tracking echocardiography is highly sensitive for detecting subtle regional contractile improvements following myocardial cell therapy that may be missed by standard wall motion assessment.
Answers are grounded in this paper and cite their sources.
Strain imaging may detect subtle BMC effects on regional LV contractility; hypothesis-generating in small ischemic cohort, prospective trials needed.
The subtle effects of transplanted bone marrow cells (BMC) on regional myocardial behavior in patients with ischemic heart disease are difficult to assess. Novel echocardiographic techniques can quantify regional myocardial deformation (strain) and distinguish between passive and active wall motion. We hypothesized that this technique may help delineate cell therapy-induced changes in regional LV contractility that escape clinical routine studies. Twelve patients with coronary artery disease and impaired LV function (LVEF &<35%) underwent CABG surgery plus intramyocardial injection of autologous bone marrow mononuclear cells. Between two and five predefined segments of ischemic myocardium per patient received BMCs, and untreated ischemic segments served as internal controls. Segmental echocardiographic analysis of peak systolic strain by speckle tracking was performed before and 1 year after surgery and compared with standard wall motion analysis. Two patients died during the follow-up period. In the remaining 10 patients, mean LVEF increased from 24.5 +/- 10% to 32.1 +/- 11% (p = 0.02). A moderate improvement of systolic function was noted in ischemic control segments by both wall motion score (WMS) and 2D strain echocardiography (2DSE). In BMC-treated segments, WMS improved slightly, but the data failed to reach statistical significance. As assessed by 2DSE, however, systolic function of BMC-treated segments improved by nearly 100%. 2DSE proved to detect BMC-induced change with 30-fold higher sensitivity than WMS, and the Receiver Operating Characteristic curve (ROC) confirmed the diagnostic precision of 2DSE (area-under-the-ROC = 0.87). We conclude that echocardiographic speckle tracking two-dimensional strain analysis can detect cell therapy-induced changes in regional contractile function that may escape detection by standard wall motion assessment. Thus, 2DSE may be a useful tool for the further development of clinical cardiac cell therapy.
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Nasseri et al. (2009) studied Coronary artery disease with impaired LV function (n=12). Intramyocardial injection of autologous bone marrow mononuclear cells vs. Untreated ischemic segments (internal controls) was evaluated on Detection of cell therapy-induced changes in regional contractile function by 2D speckle tracking echocardiography (AUC 0.87). Two-dimensional speckle tracking strain analysis detected cell therapy-induced improvements in regional contractile function with 30-fold higher sensitivity than standard wall motion score.
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