Remote ischemic preconditioning in patients with intermittent claudication

Saes, Glauco Fernandes; Zerati, Antônio Eduardo; Wolosker, Nelson; Ragazzo, Luciana; Rosoky, Ruben Miguel Ayzin; Ritti‐Dias, Raphael Mendes; Cucato, Gabriel Grizzo; Chehuen, Marcelo; Farah, Breno Quintella; Puech-Leão, Pedro

doi:10.6061/clinics/2013(04)10

Cited by 14 publications

(18 citation statements)

References 40 publications

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“…One recent study documented 'increased initial claudication distance' (the walking distance at which patients first experience symptoms) after conditioning ischemia was applied to the arm (Saes et al 2013). In contrast, this remote conditioning protocol did not increase total walking distance versus an untreated control group of patients also with intermittent claudication (Saes et al 2013). Of course, it is possible that such studies are confounded by "self-conditioning"; i.e., patients in both groups may have experienced an episode of intermittent claudication before their treadmill test.…”

Section: Clinical Relevance Of Repeated Episodes Of Ischemia-reperfusionmentioning

confidence: 99%

From Ischemic Conditioning to ‘Hyperconditioning’: Clinical Phenomenon and Basic Science Opportunity

Whittaker

Przyklenk

2014

Dose-Response

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Thousands of articles have been published on the topic of ischemic conditioning. Nevertheless, relatively little attention has been given to assessment of conditioning's dose-response characteristics. Specifically, the consequences of multiple conditioning episodes, what we will term "hyperconditioning", have seldom been examined. We propose that hyperconditioning warrants investigation because it; (1) may be of clinical importance, (2) could provide insight into conditioning mechanisms, and (3) might result in development of novel models of human disease. The prevalence of angina pectoris and intermittent claudication is sufficiently high and the potential for daily ischemia-reperfusion episodes sufficiently large that hyperconditioning is a clinically relevant phenomenon. In basic science, attenuation of conditioning-mediated infarct size reduction found in some studies after hyperconditioning offers a possible means to facilitate further discernment of cardioprotective signaling pathways. Moreover, hyperconditioning's impact extends beyond cytoprotection to tissue structural elements. Several studies demonstrate that hyperconditioning produces collagen injury (primarily fiber breakage). Such structural impairment could have adverse clinical consequences; however, in laboratory studies, selective collagen damage could provide the basis for models of cardiac rupture and dilated cardiomyopathy. Accordingly, we propose that hyperconditioning represents the dark, but potentially illuminating, side of ischemic conditioning - a paradigm that merits attention and prospective evaluation.

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Section: Clinical Relevance Of Repeated Episodes Of Ischemia-reperfusionmentioning

confidence: 99%

From Ischemic Conditioning to ‘Hyperconditioning’: Clinical Phenomenon and Basic Science Opportunity

Whittaker

Przyklenk

2014

Dose-Response

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“…This phenomenon was named remote ischemic preconditioning (RIPC) [11–13]. Saes et al [14] showed that short-term RIPC application increased the initial claudication distance in PAD patients with IC; nevertheless, RIPC did not affect the total walking distance of the study patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of Repeated Remote Ischemic Preconditioning on Peripheral Arterial Disease in Patients Suffering from Intermittent Claudication

Balın

Kıvrak

2019

Cardiovascular Therapeutics

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Background/Objective Intermittent claudication (IC) is the symptom of peripheral artery disease (PAD) and causes functional disability. Remote ischemic preconditioning (RIPC), is a phenomenon in which a short period of sub-critical ischemia, protects tissues against ischemia/reperfusion/injury. We considered to test the hypothesis that RIPC in PAD patients suffering from IC would increase muscle resistance to ischemia and thus improve walking-capacity. Materials/Methods A total of 63 patients with proven-IC underwent two treadmill tests (graded treadmill protocol) with a 28-day interval in between. Patients were consecutively assigned for the non/RIPC-group and RIPC-group procedure one by one. Patients received 5-cycles of alternating 5-minute inflation and 5-minute deflation of blood-pressure cuffs on nondominant upper-limb every day for four weeks. Initial claudication distance (ICD), total walking distance (TWD) and time to relief of claudication (TRC) were recorded during procedure. Results Patients receiving-RIPC exhibited a marked increase in ICD and TWD between basal and last tests: 209.1 ± 15.4 m vs. 226 ± 15.0 m and 368.8 ± 21.0 m vs. 394 ± 19.9 m, respectively (p < 0.001). In addition, patients receiving-RIPC represented a significant decrease in TRC between basal and last tests: 7.8 ± 1.3 min vs. 6.4 ± 1.1 min, respectively (p < 0.001). Patients not receiving-RIPC did not exhibit improvement in ICD, TWD, and TRC between basal and last tests: 205.2 ± 12.1 min vs. 207.4 ± 9.9 min, 366.5 ± 24.2 min vs. 369.4 ± 23.2 min and 7.9 ± 1.4 min vs. 7.7 ± 1.3 min, respectively (p > 0.05). Conclusion A significant increase in ICD and TWD were observed in last/treadmill test in RIPC-group. In addition, a significant decrease in TRC was observed in last/treadmill test in RIPC-group. In non/RIPC-group, no improvement was observed in ICD, TWD and TRC.

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“…Some studies examined the effects of IPC on the exercise performance of patients with coronary 31) and peripheral arterial disease 32,33) , and no improvements in exercise performance were found. However, these previous studies showed a significant improvement in clinically relevant markers.…”

Section: Population Differencesmentioning

confidence: 99%

“…However, these previous studies showed a significant improvement in clinically relevant markers. Notably, these studies used remote IPC, not IPC on the primary engaged limbs [31][32][33] . In many clinical + indicates positive effects, − indicates negative effects, and ~ indicates no effects.…”

Section: Population Differencesmentioning

confidence: 99%

Ischemic preconditioning: Potential impact on exercise performance and underlying mechanisms

Horiuchi

2017

JPFSM

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Originally, in clinical settings, ischemic preconditioning (IPC) has been used to delay cardiac cell injury and protect against myocardial and vascular damage. Furthermore, as this manipulation is relatively easy and noninvasive, previous studies have examined how IPC may have beneficial effects on exercise performance. However, because of various factors, such as different populations, exercise modes and intensities, and IPC protocols, not enough evidence is available to achieve a consensus on the impact of IPC on exercise performance, e.g., time to failure during exercise, time trial performance, and peak power. Existing evidence suggests that IPC seems not to impair exercise performance, though one study found an impairment. However, about half of the previous studies showed beneficial effects of IPC on exercise performance. Similarly, the physiological responses from IPC are varied. It is still possible that various factors, such as exercise mode and intensity, heterogeneous population and IPC protocol may affect exercise performance. Previous studies showed that effective blood flow via an increase in nitric oxide and the improvement of metabolic efficiency might be candidate factors that can explain the effect of IPC on exercise performance, although no direct evidence has been obtained. This review aims to identify potential sources of variation in these effects on exercise performance with IPC.

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Remote ischemic preconditioning in patients with intermittent claudication

Cited by 14 publications

References 40 publications

From Ischemic Conditioning to ‘Hyperconditioning’: Clinical Phenomenon and Basic Science Opportunity

From Ischemic Conditioning to ‘Hyperconditioning’: Clinical Phenomenon and Basic Science Opportunity

Effect of Repeated Remote Ischemic Preconditioning on Peripheral Arterial Disease in Patients Suffering from Intermittent Claudication

Ischemic preconditioning: Potential impact on exercise performance and underlying mechanisms

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