Remote ischaemic postconditioning protects the heart during acute myocardial infarction in pigs

Abstract

Background: Ischaemic preconditioning results in a reduction in ischaemic-reperfusion injury to the heart. This beneficial effect is seen both with direct local preconditioning of the myocardium and with remote preconditioning of easily accessible distant non-vital limb tissue. Ischaemic postconditioning with a comparable sequence of brief periods of local ischaemia, when applied immediately after the ischaemic insult, confers benefits similar to preconditioning. Objective: To test the hypothesis that limb ischaemia induces remote postconditioning and hence reduces experimental myocardial infarct size in a validated swine model of acute myocardial infarction. Methods: Acute myocardial infarction was induced in 24 pigs with 90 min balloon inflations of the left anterior descending coronary artery. Remote ischaemic postconditioning was induced in 12 of the pigs by four 5 min cycles of blood pressure cuff inflation applied to the lower limb immediately after the balloon deflation. Infarct size was assessed by measuring 72 h creatinine kinase release, MRI scan and immunohistochemical analysis. Results: Area under the curve of creatinine kinase release was significantly reduced in the postconditioning group compared with the control group with a 26% reduction in the infarct size (p,0.05). This was confirmed by MRI scanning and immunohistochemical analysis that revealed a 22% (p,0.05) and a 47.52% (p,0.01) relative reduction in the infarct size, respectively. Conclusion: Remote ischaemic postconditioning is a simple technique to reduce infarct size without the hazards and logistics of multiple coronary artery balloon inflations. This type of conditioning promises clear clinical potential.

Ischemic limb preconditioning downregulates systemic inflammatory activation

“…The use of limbs is one of the most promising possibilities of evolving both pre-and postconditioning ischemic tolerance. 28,29 The major beneficiary of these approaches is the heart, 29 but the kidney, 30 distant muscle, 31 liver, 32 lung, 15 or CNS 33 can also be targeted. With respect to remote preconditioning, the present study has two messages.…”

Remote ischemic conditioning: Short-term effects on rat liver ischemic-reperfusion injury

“…Lai és mtsai 2006-ban igazolták a távoli szervi prekondicionálás hatékonyságát patkánymájmodellben, alsó végtagi IRciklusokat alkalmazva távoli szervi kondicionálási stimulusként [23]. Következő lépés a célszervi posztkondicionálás mintájára kidolgozott távoli szervi ischaemiás posztkondicionálás volt [24], amely gyakorlati szempontból előnyösebb metodika, hiszen alkalmazásakor az ischaemiás inzultus idejét nem szükséges előre ismerni. Technikai kivitelezhetőség tekintetében még kedvezőbb tulajdonságokkal jellemezhető az általunk vizsgált távoli szervi ischaemiás perkondicionálás, amelyet Schmidt és munkatársai alkalmaztak először 2007-ben [10].…”

A study to find out the effect of remote ischemic post conditioning of lower limb in patients of acute myocardial infarction undergoing primary percutaneous coronary intervention

“…The prevalence of diabetes has increased in India in last two decades and high prevalence of diabetes in study group indicates its strong correlation with AMI. 6 There was no statistical significant difference of ejection fraction between case (45.7±6.0) and control (46.2±7) groups (p=0.69). 10 (50%) patients in case group had LAD, 4 (20%) patients had LCX and 6(30%) patients had RCA as their culprit vessel respectively.…”