The effects of remote ischaemic preconditioning on coronary artery function in patients with stable coronary artery disease

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:252

Article

Corcoran, D.^1,2  Young, R.³  Cialdella, P.²  McCartney, P.^1,2  Bajrangee, A.²  Hennigan, B.^1,2  Collison, D.¹  Carrick, D.²  Shaukat, A.²  Good, R.²  Watkins, S.²  McEntegart, M.²  Watt, J.²  Welsh, P.¹  Sattar, N.¹  McConnachie, A.³  Oldroyd, K. G.²  Berry, C.^1,2 

[1] Univ Glasgow, British Heart Fdn, Glasgow Cardiovasc Res Ctr, Glasgow, Lanark, Scotland

[2] Golden Jubilee Natl Hosp, West Scotland Heart & Lung Ctr, Glasgow, Lanark, Scotland

[3] Univ Glasgow, Robertson Ctr Biostat, Glasgow, Lanark, Scotland

关键词: Remote ischaemic preconditioning;    Coronary artery disease;    Endothelial function;    Cardioprotection;    Myocardial infarction;   

DOI  :  10.1016/j.ijcard.2017.10.082

来源: Elsevier

【 摘 要 】

Background: Remote ischaemic preconditioning (RIPC) is a cardioprotective intervention invoking intermittent periods of ischaemia in a tissue or organ remote from the heart. The mechanisms of this effect are incompletely understood. We hypothesised that RIPC might enhance coronary vasodilatation by an endothelium-dependent mechanism. Methods: We performed a prospective, randomised, sham-controlled, blinded clinical trial. Patients with stable coronary artery disease (CAD) undergoing elective invasive management were prospectively enrolled, and randomised to RIPC or sham (1:1) prior to angiography. Endothelial-dependent vasodilator function was assessed in a non-target coronary artery with intracoronary infusion of incremental acetylcholine doses (10(-6) , 10(-5) ,10(-4) mol/l). Venous blood was sampled pre- and post-RIPC or sham, and analysed for circulating markers of endothelial function. Coronary luminal diameter was assessed by quantitative coronary angiography. The primary outcome was the between-group difference in the mean percentage change in coronary luminal diameter following the maximal acetylcholine dose. Results: 75 patients were enrolled. Following angiography, 60 patients (mean +/- SD age 57.5 +/- 8.5 years: 80% male) were eligible and completed the protocol (n = 30 RIPC, n = 30 sham). The mean percentage change in coronary luminal diameter was - 13.3 +/- 22.3% and - 2.0 +/- 17.2% in the sham and RIPC groups respectively (difference 11.32%, 95%Cl: 1.2- 21.4, p = 0.032). This remained significant when age and sex were included as covariates (difference 11.01%, 95%Cl: 1.01- 21.0, p = 0.035). There were no between-group differences in endothelial-independent vasodilation, ECG parameters or circulating markers of endothelial function. Conclusions: RIPC attenuates the extent of vasoconstriction induced by intracoronary acetylcholine infusion. This endothelium-dependent mechanism may contribute to the cardioprotective effects of RIPC. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.

【 授权许可】

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