title: Percutaneous endocardial injection of erythropoietin: assessment of cardioprotection by electromechanical mapping.
abstract: 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 NOGA 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 NOGA guided percutaneous transendocardial injection catheter, MYOSTAR. 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.
  
  
  CONCLUSIONS
  Endocardial EPO injection may induce cardioprotective effects in hibernating myocardium and may attenuate the progression of ischaemic tissue damage.
authors.affiliation: Cardiology, St. Georg Hospital, Hamburg, Germany. korff.krause@web.de
authors.forename: Korff T
authors.initials: KT
authors.lastname: Krause
authors.forename: Kai
authors.initials: K
authors.lastname: Jaquet
authors.forename: Stephan
authors.initials: S
authors.lastname: Geidel
authors.forename: Carsten
authors.initials: C
authors.lastname: Schneider
authors.forename: Christina
authors.initials: C
authors.lastname: Mandel
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Stoll
authors.forename: Klaus
authors.initials: K
authors.lastname: Hertting
authors.forename: Tobias
authors.initials: T
authors.lastname: Harle
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000818:Animals; D002908:Chronic Disease; D003326:Coronary Circulation / Q000502:physiology; D004195:Disease Models, Animal; D018450:Disease Progression; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D004699:Endocardium; D004921:Erythropoietin / Q000008:administration & dosage*; D007091:Image Processing, Computer-Assisted; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017682:Myocardial Stunning / Q000503:physiopathology; D013552:Swine; D014463:Ultrasonography
chemical_list: D004921:Erythropoietin