N. Ajmone Marsan

Effect of intramyocardial bone marrow cell injection on left ventricular dyssynchrony and global strain

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.

ST-segment elevation associated with allergic reaction to echocardiographic contrast agent administration

We report a case of an allergic reaction after the administration of an echocardiographic contrast agent which resulted in ST-segment elevation. Hypersensitivity and allergic reactions are known causes of acute cardiovascular events. However, only limited reports are available which suggest the exact mechanism of the occurrence of angina or myocardial infarction during severe allergic reactions. In our case, through invasive imaging (coronary angiography and IVUS) we have shown for the first time a transient coronary spasm in the absence of intra-coronary thrombus and only minimal neointimal hyperplasia.

21 Feature tracking cardiac magnetic resonance to assess LV mechanics in different cardiac overload caused by aortic valve disease

Background In aortic valve disease, left ventricular (LV) dimensions and ejection fraction are important parameters for decision making. However, the effects of pressure overload caused by aortic stenosis or/and volume overload, due to aortic regurgitation, lead to different LV remodelling, concentric and eccentric hypertrophy, respectively, which may differently alter LV mechanics. We aimed to characterise LV mechanics, in terms of longitudinal strain/deformation using feature tracking cardiac magnetic resonance (FT-CMR) in patients with various degree of aortic stenosis and aortic regurgitation and preserved LV ejection fraction (LVEF). Methods Seventy-one patients (14 with normal valve function, 29 with aortic stenosis and 28 with aortic regurgitation), mean age 45 ± 19 years, 70% men, who underwent clinically indicated CMR and showed preserved LVEF (>50%) were included. LV volumes, LVEF and mass were measured on steady-state free precession (SSFP) cine images. FT-CMR analysis was performed offline using tissue-tracking software (CVI42, Circle Cardiovascular Imaging Inc.) to estimate LV global longitudinal strain (GLS) from two long-axis SSFP cine images (Figure 1). To correct for the LV remodelling process, LV GLS was corrected for LV end-diastolic volume. Results There were significant differences in LV volumes, mass and ejection fraction across the 3 groups of patients (Table 1): patients with aortic regurgitation showed significantly larger LV volumes, and lower LVEF compared to patients with normal aortic valve function and patients with aortic stenosis. There were no differences in LV GLS across the groups. However, after correcting for LV end-diastolic volume, patients with aortic regurgitation showed more impaired LV GLS as compared to the other groups. Abstract 21 Table 1 CMR characteristics Normal valve function (n = 14) Aortic stenosis (n = 29) Aortic regurgitation (n = 28) ANOVA p-value Heart rate (beats/min) 71 ± 8 70 ± 12 64 ± 13 0.132 LVEDV (ml) 135 ± 33 138 ± 33 186 ± 50 * <0.001 LVESV (ml) 46 ± 15 43 ± 16 70 ± 22 * <0.001 LVEF (%) 65 ± 5 69 ± 6 62 ± 5† <0.001 LV mass (gr) 120 ± 29 # 153 ± 36 157 ± 35 0.005 GLS (%) −19.2 ± 3.4 −19.3 ± 3.6 −19.8 ± 3.0 0.813 LV GLS/LVEDV −0.15 ± 0.05 −0.14 ± 0.04 −0.12 ± 0.04 * 0.01 * p < 0.001 vs. Aortic stenosis and normal; †p < 0.001 vs. Aortic stenosis; # p < 0.001 vs. Aortic regurgitation and Aortic stenosis. Conclusions LV mechanics significantly differ across normal functioning and different type of aortic valve dysfunction (stenosis and regurgitation), with aortic regurgitation showing the most impaired LV GLS corrected for LV end-diastolic volume, despite preserved LVEF. Abstract 21 Figure 1 Assessment of LV GLS with FT-CMR. From two long-axis SSFP cine images, the time-GLS curve is obtained and peak LV GLS is determined