Schneider Carsten, Jaquet Kai, Malisius Rainer, Geidel Stephan, Bahlmann Edda, Boczor Sigrid, Rau Thomas, Antz Matthias, Kuck Karl-Heinz, Krause Korff
Department of Cardiology, Asklepios Klinik, St. Georg II. Med. Abteilung (Kardiologie), Lohmühlenstrasse 5, 20099 Hamburg, Germany.
Eur Heart J. 2007 Feb;28(4):499-509. doi: 10.1093/eurheartj/ehl439. Epub 2007 Jan 22.
The aim of this study was to investigate whether erythropoietin (EPO) has cardioprotective effects in a chronic myocardial ischaemia model regarding strain-rate imaging parameters during dobutamine stress echocardiography (DSE).
An ameroid constrictor was placed around the circumflex artery in 13 pigs to induce hibernating myocardium by a chronic vessel occlusion. The pigs were randomized 14 days later: seven pigs receiving 10,000 U EPO and six pigs receiving placebo injected into the ischaemic region using a NOGAtrade mark-guided transendocardial catheter. At weeks 2 and 6, animals were examined by DSE, electromechanical mapping, and coronary angiography. During incremental dobutamine infusion, regional radial function was monitored by measuring peak systolic strain-rates (SRsys), systolic strains (epsilonsys), and post-systolic strains (epsilonps). At week 6, the animals were pathohistologically investigated. Echocardiography revealed 2.2+/-0.8 hypokinetic segments in the EPO-treated animals in comparison with 3.3+/-0.9 akinetic segments per animal in the controls. The mean ejection fraction was reduced in the control group (55+/-3 vs. 66+/-4%, P=0.057). Strain-rate imaging revealed ischaemic myocardium in EPO-treated animals and non-viable myocardium in the controls (P=0.0001). Histological analysis of the ischaemic region revealed a reduction of myocardial fibrosis (8+/-1 vs. 27+/-5%) in the EPO-treated group. The transmural extension of fibrosis and the echocardiographic deformation data correlated in the posterior walls (EPO group): epsilonsys at rest r=0.83; peak SRsys during dobutamine stimulation r=0.92, P=0.01.
Endocardial EPO injection may induce cardioprotective effects in chronic ischaemic myocardium and helps to obtain the myocardial contractile reserve, objectified by ultrasonic strain-rate imaging.
本研究旨在探讨促红细胞生成素（EPO）在慢性心肌缺血模型中，对于多巴酚丁胺负荷超声心动图（DSE）期间的应变率成像参数是否具有心脏保护作用。
对13头猪在回旋支动脉周围放置 ameroid 缩窄环，通过慢性血管闭塞诱导冬眠心肌。14天后将猪随机分组：7头猪接受10000 U EPO，6头猪接受安慰剂，使用 NOGA 商标引导的经心内膜导管注入缺血区域。在第2周和第6周，通过DSE、机电标测和冠状动脉造影对动物进行检查。在多巴酚丁胺递增输注期间，通过测量收缩期峰值应变率（SRsys）、收缩期应变（epsilonsys）和收缩后期应变（epsilonps）监测局部径向功能。在第6周，对动物进行病理组织学研究。超声心动图显示，EPO治疗组动物有2.2±0.8个运动减弱节段，而对照组动物每只平均有3.3±0.9个运动不能节段。对照组的平均射血分数降低（55±3% 对66±4%，P = 0.057）。应变率成像显示，EPO治疗组动物存在缺血心肌，而对照组为无存活心肌（P = 0.0001）。缺血区域的组织学分析显示，EPO治疗组心肌纤维化减少（8±1% 对27±5%）。后壁纤维化的透壁延伸与超声心动图变形数据相关（EPO组）：静息时的epsilonsys r = 0.83；多巴酚丁胺刺激时的峰值SRsys r = 0.92，P = 0.01。
心内膜注射EPO可能对慢性缺血心肌产生心脏保护作用，并有助于获得心肌收缩储备，这通过超声应变率成像得以客观化。
