© 2005 European Society of Cardiology
Percutaneous endocardial injection of erythropoietin: Assessment of cardioprotection by electromechanical mapping
a Cardiology, St. Georg Hospital Hamburg, Germany
b Cardiac Surgery, St. Georg Hospital Hamburg, Germany
c Institute of Experimental Oncology and Therapy Research, Technical University of Munich Munich, Germany
d Cordis European Head Quarter Waterloo, Belgium
* Corresponding author. AK St. Georg, Herzkatheterlabor, Lohmühlenstr. 5, 20099 Hamburg, Germany. Tel.: +49 40 2890 2033; fax: +49 40 2890 4444. Email address: korff.krause{at}web.de
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Abstract |
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Background: Apart from its well-known stimulation of erythropoiesis, erythropoietin (EPO) exhibits angiogenic and anti-apoptotic effects. These cellular protective effects have also been described in experimental acute myocardial infarction models. We investigated the effects of EPO in a porcine model of chronic progressive myocardial ischaemia.
Methods: At weeks 2 and 6 after implantation of a circumflex ameroid constrictor, endocardial electromechanical NOGATM system (Biosense Webster, Inc., California, USA) mapping of the left ventricle, coronary and ventricular angiography, as well as echocardiography were performed. Two weeks after ameroid placement, 13 pigs were randomized with 7 pigs receiving 10.000 U EPO and 6 pigs receiving placebo into the ischaemic region using a NOGATM guided percutaneous transendocardial injection catheter, MYOSTARTM. After 6 weeks, histology (Masson's Trichrome) was analyzed.
Results: Endocardial electromechanical mapping showed an increase of mean unipolar voltage (UV) amplitude in the ischaemic myocardial segments in the EPO-treated animals (8.5 mV pre and 10.6 mV post treatment) and a significantly reduced ischaemic surface area compared to the control group (19% vs. 41%) suggesting a decline in ischaemic injury. Echocardiography revealed 2,2 hypokinetic segments of the lateral wall in the EPO group vs. 3,3 in the control groups. The mean ejection fraction was 64% in the EPO group and 55% in the placebo group. Quantitative histological analysis of the ischaemic regions revealed a reduction of myocardial fibrosis (8% vs. 28%) in the EPO group.
Conclusion: Endocardial EPO injection may induce cardioprotective effects in hibernating myocardium and may attenuate the progression of ischaemic tissue damage.
Key Words: Percutaneous endocardial injection • Cardioprotection • Electromechanical mapping
Received April 10, 2005; Revised August 4, 2005; Accepted October 20, 2005
1 Equally contributed to this article.
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