Orii Makoto, Hirata Kumiko, Takemoto Kazushi, Akasaka Takashi
Department of Radiology, Iwate Medical University, Morioka, Japan.
Division of Medical Science, Department of Education, Osaka Educational University, Osaka, Japan.
Cardiol Ther. 2018 Dec;7(2):151-162. doi: 10.1007/s40119-018-0122-1. Epub 2018 Oct 23.
Cardioprotective effects of erythropoietin (EPO) on infarcted myocardium in acute myocardial infarction (AMI) patients have been inconclusive. This study aimed to assess the effect of EPO administration on coronary microvascular dysfunction (CMD) and myocardial viability in anterior AMI. We also evaluated the serial changes in CMD and cardiac remodeling in these patients.
Patients with a successful percutaneous coronary intervention (PCI) for the first anterior AMI were randomly assigned to two groups (EPO and control groups), and given single-dose intravenous administration of recombinant human EPO (12,000 IU) or saline after PCI. Delayed-enhanced cardiac magnetic resonance imaging was performed at 1 week after AMI to assess the average of transmural extent of infarction and infarct size. Coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery was measured by Doppler echocardiography at 1 week, 1 month, and 8 months after AMI. All patients underwent clinical follow-up for the assessment of cardiac remodeling.
Sixty-one patients (EPO 32, control 29) were eligible for analysis. EPO group (2.4 ± 1.2) had a tendency of smaller transmural extent of infarction than that of control group (2.9 ± 1.1; p = 0.063). CFVR-8 months improved significantly in EPO group (2.9 ± 0.6) compared to control group (2.6 ± 0.5; p = 0.04). Left atrial (LA) volume - 8 months was significantly lower in EPO group (47 ± 11) than those of control group (65 ± 20; p = 0.004).
A single medium dose of EPO could have a favorable effect on CMD and LA remodeling in the chronic phase of anterior AMI.
The institutional ethics committee of Wakayama Medical University, identifier, 1125.
促红细胞生成素（EPO）对急性心肌梗死（AMI）患者梗死心肌的心脏保护作用尚无定论。本研究旨在评估EPO给药对前壁AMI患者冠状动脉微血管功能障碍（CMD）和心肌活力的影响。我们还评估了这些患者CMD和心脏重塑的系列变化。
首次前壁AMI成功接受经皮冠状动脉介入治疗（PCI）的患者被随机分为两组（EPO组和对照组），并在PCI后给予单剂量静脉注射重组人EPO（12,000 IU）或生理盐水。在AMI后1周进行延迟强化心脏磁共振成像，以评估梗死透壁范围和梗死面积的平均值。通过多普勒超声心动图在AMI后1周、1个月和8个月测量左前降支冠状动脉的冠状动脉血流储备（CFVR）。所有患者均接受临床随访以评估心脏重塑。
61例患者（EPO组32例，对照组29例）符合分析条件。EPO组（2.4±1.2）的梗死透壁范围有小于对照组（2.9±1.1；p=0.063）的趋势。与对照组（2.6±0.5；p=0.04）相比，EPO组8个月时的CFVR显著改善（2.9±0.6）。EPO组8个月时的左心房（LA）容积（47±11）显著低于对照组（65±20；p=0.004）。
单剂量中等剂量的EPO可能对前壁AMI慢性期的CMD和LA重塑有有益作用。
和歌山医科大学机构伦理委员会，标识符，1125。
