Remote ischemic conditioning improves coronary microcirculation in healthy subjects and patients with heart failure

Abstract

BackgroundRemote ischemic conditioning (RIC) is a treatment modality that suppresses inflammation and improves endothelial function, which are factors involved in the pathogenesis of heart failure (HF) with reduced left ventricular ejection fraction. Coronary flow reserve (CFR) is a physiological index of coronary microcirculation and is noninvasively measured by transthoracic Doppler echocardiography (TTDE). This study aimed to investigate the effects of RIC on CFR in healthy subjects and patients with HF, through the assessment by TTDE.MethodsTen patients with HF with left ventricular ejection fraction of less than 40%, and ten healthy volunteers were enrolled in this study. RIC treatment was performed twice a day for 1 week. Our custom-made RIC device was programmed to automatically conduct 4 cycles of 5 minutes inflation and 5 minutes deflation of a blood pressure cuff to create intermittent arm ischemia. CFR measurements and laboratory tests were examined before, and after 1 week of RIC treatment.ResultsOne week of RIC treatment was well tolerated in both groups. RIC treatment increased CFR from 4.0±0.9 to 4.6±1.3 (mean ± standard deviation) in healthy subjects (P=0.02), and from 1.9±0.4 to 2.3±0.7 in patients with HF (P=0.03), respectively. Systolic blood pressure in healthy subjects, and heart rate in HF patients decreased after RIC treatment (both P<0.01).ConclusionThis study demonstrated that a 1 week course of RIC treatment improved coronary microcirculation in healthy subjects and patients with HF associated with reduced left ventricular ejection fraction.

The Coronary Circulation as a Target of Cardioprotection

“…177 In healthy young volunteers, repeated remote ischemic conditioning twice a day for 1 week increased coronary flow reserve, and it did so also in patients with heart failure. 178 In patients undergoing elective percutaneous coronary revascularization, remote ischemic preconditioning did not reduce coronary microvascular resistance in a nontarget vessel. 179 In the Effect of Remote Ischemic Conditioning Before Hospital Admission (CONDI) trial, in patients undergoing primary PCI for acute myocardial infarction, remote ischemic perconditioning with 4 cycles of 5-minute arm ischemia/5-minute reperfusion during transport in the ambulance reduced infarct size but did not improve coronary blood flow.…”

Clinical translation of myocardial conditioning

“…These findings were recently supported by another rat study showing a similar beneficial effect even when RIC treatment was not commenced before 4 wk after myocardial infarction (323). In humans, repeated RIC modifies the human inflammatory response and leukocyte adhesion (260) and improves coronary microcirculation in healthy volunteers and patients with heart failure (124,138,147). Currently, two ongoing clinical trials [the Daily REmote Ischemic Conditioning Following Acute Myocardial Infarction (DREAM) study, available at https://clinicaltrials.gov/ct2/ show/NCT01664611, and the Chronic Remote Ischemic Conditioning to Modify Post-MI Remodeling (CRIC-RCT study), available at https://clinicaltrials.gov/ct2/show/NCT01817114] are investigating the effect of prolonged RIC on ventricular function in patients with reduced ventricular function after an acute coronary event.…”

Tefillin use induces remote ischemic preconditioning pathways in healthy men

“…Indeed, Shimizu and colleagues (45) found that IL-1␤ and IL-10 were unaltered after day 1 but significantly increased after day 10 of RIPC. Furthermore, Kono and colleagues (25) demonstrated that 10 patients with chronic heart failure had decreased TNF␣, IL-6, troponin T, and brain natriuretic peptide after 7 days of RIPC stimulation compared with basal levels. Our results demonstrate acute tefillin did not alter circulating chemokines and leukocyte cell surface receptors (vs. basal levels).…”