Abstract
Introduction: Remote ischaemic preconditioning (RIPC) confers cardioprotection during percutaneous coronary intervention (PCI). Coronary microcirculatory function is prognostically important during PCI. Remote ischaemic preconditioning is likely to be mediated by a factor in the circulation. The aim of this study was to assess the effect of RIPC on coronary microcirculatory function, and to explore potential circulating mediators.
Methods: Patients referred for cardiac catheterisation and fractional flow reserve were randomised to RIPC (3 × 5 minutes 200 mmHg sphygmomanometer inflations, left arm, separated by 5 minutes of deflation) or sham (10 mmHg). Comprehensive physiological assessments were performed before and after RIPC or sham using a pressure-temperature sensor wire. Measurements taken included index of microcirculatory resistance (IMR) and coronary flow reserve (CFR). Plasma stored before and immediately after RIPC or sham underwent mass spectrometry to study RIPC-mediated changes in proteomic profile, with correction (Benjamini-Hochberg) performed to reduce the false discovery rate.
Results: Thirty patients were recruited (15 RIPC, 15 sham)—87% were male, mean age was 63.1 ± 10.0 years—with similar baseline between-group characteristics. Remote ischaemic preconditioning decreased IMR (22.6, range 17.9–25.6 vs 17.5, range 14.5–21.3, p = 0.007) and increased CFR (2.6 ± 0.9 vs 3.8 ± 1.7, p = 0.001). There were two proteins that increased with RIPC (Annexin-A1 and Mediator of RNA polymerase II transcription subunit-13) and six proteins that decreased (Mitogen-activated protein kinase-5, Probable ATP-dependent RNA helicase, Phosphoglycerate kinase-1, Nucleobindin-1, Calpain-2 catalytic subunit, and Symplekin), but none remained significant after correction.
Conclusions: Remote ischaemic preconditioning lead to an improvement in coronary microcirculatory function, which may have contributed to the improved outcomes during PCI. Several potential candidate mediators were identified but require external validation.
Methods: Patients referred for cardiac catheterisation and fractional flow reserve were randomised to RIPC (3 × 5 minutes 200 mmHg sphygmomanometer inflations, left arm, separated by 5 minutes of deflation) or sham (10 mmHg). Comprehensive physiological assessments were performed before and after RIPC or sham using a pressure-temperature sensor wire. Measurements taken included index of microcirculatory resistance (IMR) and coronary flow reserve (CFR). Plasma stored before and immediately after RIPC or sham underwent mass spectrometry to study RIPC-mediated changes in proteomic profile, with correction (Benjamini-Hochberg) performed to reduce the false discovery rate.
Results: Thirty patients were recruited (15 RIPC, 15 sham)—87% were male, mean age was 63.1 ± 10.0 years—with similar baseline between-group characteristics. Remote ischaemic preconditioning decreased IMR (22.6, range 17.9–25.6 vs 17.5, range 14.5–21.3, p = 0.007) and increased CFR (2.6 ± 0.9 vs 3.8 ± 1.7, p = 0.001). There were two proteins that increased with RIPC (Annexin-A1 and Mediator of RNA polymerase II transcription subunit-13) and six proteins that decreased (Mitogen-activated protein kinase-5, Probable ATP-dependent RNA helicase, Phosphoglycerate kinase-1, Nucleobindin-1, Calpain-2 catalytic subunit, and Symplekin), but none remained significant after correction.
Conclusions: Remote ischaemic preconditioning lead to an improvement in coronary microcirculatory function, which may have contributed to the improved outcomes during PCI. Several potential candidate mediators were identified but require external validation.
| Original language | English |
|---|---|
| Article number | 0664 |
| Pages (from-to) | S342 |
| Number of pages | 1 |
| Journal | Heart, Lung and Circulation |
| Volume | 27 |
| Issue number | Supplement 2 |
| DOIs | |
| Publication status | Published - 2018 |
| Event | 66th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, the International Society for Heart Research Australasian Section Annual Scientific Meeting and the 12th Annual Australia and New Zealand Endovascular Therapies Meeting - Brisbane, Australia Duration: 2 Aug 2018 → 5 Aug 2018 |