Cardiac Remote Ischemic Preconditioning Research Articles

Is Cardiac Remote Ischemic Preconditioning (RIPC) More Beneficial in Patients with Diabetes to Reduce Cardiac Troponin I After Elective Percutaneous Coronary Intervention (PCI)?

Background: Intervention of choice for reperfusion is percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD), but it may have side effects; one of which is myocardial injury. Cardiac remote ischemic preconditioning (RIPC) can potentially reduce these adverse effects, especially in patients with cardiovascular risk factors. Methods: This study received ethics approval on November 29, 2017 (ethics code: HUMS.REC.1396.93; IRCT code: IRCT20180306038978N1). It was performed on 240 patients (120 cases in the RIPC group and 120 cases in the control group). The patients undergoing PCI were randomly assigned to the RIPC group (blood pressure cuff was inflated up to 200 mmHg for 30 minutes on the non-dominant arm, and then deflated for 5 minutes (reperfusion); it was repeated 2 more times (3 times in general) or the control group (an uninflated cuff around the non-dominant arm). Cardiac troponin I (cTnI) was compared between the healthy controls and diabetic patients before and after PCI. Results: No significant difference was observed with regard to positive cTnI (P = 0.136). Positive cTnI was insignificantly higher in the control group compared to the intervention group. However, the frequency of positive cTnI was significantly lower in diabetic patients in the RIPC group compared to the controls (P < 0.001). Conclusions: This study demonstrated that RIPC is beneficial in diabetic patients and reduces the release of cTnI after elective PCI in these patients.

A Nontargeted UHPLC-HRMS Metabolomics Pipeline for Metabolite Identification: Application to Cardiac Remote Ischemic Preconditioning.

In recent years, the number of investigations based on nontargeted metabolomics has increased, although often without a thorough assessment of analytical strategies applied to acquire data. Following published guidelines for metabolomics experiments, we report a validated nontargeted metabolomics strategy with pipeline for unequivocal identification of metabolites using the MSMLS molecule library. We achieved an in-house database containing accurate m/z values, retention times, isotopic patterns, full MS, and MS/MS spectra. A UHPLC-HRMS Q-Exactive method was developed, and experimental variations were determined within and between 3 experimental days. The extraction efficiency as well as the accuracy, precision, repeatability, and linearity of the method were assessed, the method demonstrating good performances. The methodology was further blindly applied to plasma from remote ischemic pre-conditioning (RIPC) rats. Samples, previously analyzed by targeted metabolomics using completely different protocol, analytical strategy, and platform, were submitted to our analytical pipeline. A combination of multivariate and univariate statistical analyses was employed. Selection of putative biomarkers from OPLS-DA model and S-plot was combined to jack-knife confidence intervals, metabolites' VIP values, and univariate statistics. Only variables with strong model contribution and highly statistical reliability were selected as discriminated metabolites. Three biomarkers identified by the previous targeted metabolomics study were found in the current work, in addition to three novel metabolites, emphasizing the efficiency of the current methodology and its ability to identify new biomarkers of clinical interest, in a single sequence. The biomarkers were identified to level 1 according to the metabolomics standard initiative and confirmed by both RPLC and HILIC-HRMS.

Remote Ischemic Preconditioning Improves Outcome at 6 Years After Elective Percutaneous Coronary Intervention

Postprocedural myocardial infarction (type 4a) has been shown to be an adverse prognostic indicator after elective percutaneous coronary intervention (PCI). The Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) study demonstrated that remote ischemic preconditioning reduced procedural symptoms, ECG ST-segment deviation, and cardiac troponin I release after elective PCI and reduced the major adverse cardiac and cerebral event (MACCE) rate at 6 months. We were interested to confirm if this early benefit in MACCE rate in the remote ischemic preconditioning group was sustained long-term. Patients were telephoned by researchers blinded to the randomization details. MACCE, defined as all-cause mortality, nonfatal myocardial infarction, transient ischemic attack or stroke, and heart failure requiring hospital admission, were adjudicated by case note and national database review. One hundred ninety-two (89.3%) of the 225 patients with elective PCI randomized in the original study were available for long-term follow-up (mean time to event or last follow-up: 1579.7±603.6 days). There were a total of 59 (30.7%) MACCEs. Patients with an MACCE had a higher mean cardiac troponin I after PCI (±SD): 2.07±6.99 versus 0.91±2.07 ng/mL (P=0.05). The MACCE rate at 6 years remained lower in the remote ischemic preconditioning group (hazard ratio, 0.58; 95% confidence interval, 0.35-0.97; P=0.039; absolute risk reduction=0.13 and number needed to treat=8 to prevent the MACCE at 6 years). Remote ischemic preconditioning reduces the incidence of postprocedural cardiac troponin I after elective PCI and confers an MACCE-free survival benefit at both short- and long-term follow-up. URL: http://www.ukcrn.org.uk. Unique identifier: UKCRN 4074.

Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: A Prospective, Randomized Control Trial

Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study: A Prospective, Randomized Control Trial

Clinical Application of Remote Ischemic Preconditioning

Ischemic preconditioning1 has been shown to reliably reduce ischemic myocardial cell necrosis in a host of animal models.2 Although preconditioning is one of the most powerful and reproducible phenomena in cardioprotection, it has not readily translated to routine clinical use. One issue is that the timing of the long duration of ischemia must be known in advance and the treatment must be applied before the long duration of ischemia. Thus, although evidence suggests that preinfarction ischemia (angina) before an ST-segment elevation myocardial infarction is associated with smaller infarct size and better clinical outcome,3 there is no reliable way to predict when a myocardial infarction will occur and hence no way to either induce ischemic preconditioning or apply a preconditioning mimetic agent just before the infarction. There are, of course, situations in which myocardial ischemia is planned, eg, during coronary artery balloon angioplasty, during coronary artery bypass surgery, during excision and transportation of a donor heart, and before exercise in a patient with known demand-induced ischemia. Preconditioning has been applied to some of these situations. For example, multiple brief balloon inflations and deflations in the coronary artery reduce the severity of chest pain, ST-segment elevation, and lactate production on subsequent balloon inflations compared with an initial balloon inflation without necessarily recruiting blood flow.4 Intermittent aortic cross clamping before coronary artery bypass surgery has been observed to preserve cardiac high-energy phosphate levels.2 These examples of ischemic preconditioning require an invasive procedure to induce ischemia within the heart and the possibility of showering atherosclerotic emboli either down the coronaries or into the aorta as a coronary angioplasty balloon is repeatedly inflated or deflated or the aortic cross clamp is repeatedly clamped and unclamped. Article p 820 Another approach exists that has the potential to be entirely noninvasive: remote …

Cardiac Remote Ischemic Preconditioning in Coronary Stenting (CRISP Stent) Study

Myocyte necrosis as a result of elective percutaneous coronary intervention (PCI) occurs in approximately one third of cases and is associated with subsequent cardiovascular events. This study assessed the ability of remote ischemic preconditioning (IPC) to attenuate cardiac troponin I (cTnI) release after elective PCI. Two hundred forty-two consecutive patients undergoing elective PCI with undetectable preprocedural cTnI were recruited. Subjects were randomized to receive remote IPC (induced by three 5-minute inflations of a blood pressure cuff to 200 mm Hg around the upper arm, followed by 5-minute intervals of reperfusion) or control (an uninflated cuff around the arm) before arrival in the catheter laboratory. The primary outcome was cTnI at 24 hours after PCI. Secondary outcomes included renal dysfunction and major adverse cardiac and cerebral event rate at 6 months. The median cTnI at 24 hours after PCI was lower in the remote IPC compared with the control group (0.06 versus 0.16 ng/mL; P=0.040). After remote IPC, cTnI was <0.04 ng/mL in 44 patients (42%) compared with 24 in the control group (24%; P=0.01). Subjects who received remote IPC experienced less chest discomfort (P=0.0006) and ECG ST-segment deviation (P=0.005) than control subjects. At 6 months, the major adverse cardiac and cerebral event rate was lower in the remote IPC group (4 versus 13 events; P=0.018). Remote IPC reduces ischemic chest discomfort during PCI, attenuates procedure-related cTnI release, and appears to reduce subsequent cardiovascular events.

Remote Ischemic Preconditioning Stimulus Does Not Reduce Microvascular Resistance or Improve Myocardial Blood Flow in Patients Undergoing Elective Percutaneous Coronary Intervention

Remote ischemic preconditioning (RIPC) may limit myocardial infarction by improving microvascular function and maintaining myocardial blood flow. We hypothesized that a RIPC stimulus would reduce coronary microvascular resistance and improve coronary blood flow during elective percutaneous coronary intervention (PCI). We prospectively recruited 54 patients with multi-vessel disease (MVD = 32) or single vessel disease awaiting elective PCI. Patients with MVD had non-target vessel (NTV) index of micro-circulatory resistance (IMR) determined, before and after target vessel (TV) PCI (cardiac RIPC). The effect of arm RIPC on serial microvascular resistance (R(p)) was assessed in patients with single vessel disease. TV balloon occlusion did not alter the NTV IMR: 16.5 (12.4) baseline vs. 17.6 (11.6) post cardiac RIPC, P = 0.65 or hyperaemic transit time. Arm RIPC did not alter R( p) in patients with single vessel disease: Rp, mmHg.cm(-1).s( -1): 3.5 (1.9) baseline vs. 4.1 (3.0) post arm RIPC, P = 0.19 and coronary flow velocity remained constant. RIPC stimuli during elective PCI do not affect coronary microvascular resistance or coronary flow in humans.