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Published on: May 28, 2019
Remote ischemic preconditioning stimulus does not reduce microvascular resistance or improve myocardial blood flow in
Stephen P Hoole1, Patrick M Heck, Paul A White
1Department of Cardiovascular Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, United Kingdom.
Insights
Remote ischemic preconditioning (RIPC) did not improve coronary microvascular resistance or blood flow during percutaneous coronary intervention (PCI) in patients. This study found no benefit of RIPC in this clinical setting.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- Remote ischemic preconditioning (RIPC) is explored for its potential to limit myocardial infarction.
- RIPC may enhance microvascular function and maintain myocardial blood flow.
- The study investigates RIPC's effects during elective percutaneous coronary intervention (PCI).
Purpose of the Study:
- To test if RIPC reduces coronary microvascular resistance.
- To determine if RIPC improves coronary blood flow during PCI.
- To evaluate RIPC's impact on microvascular function in patients undergoing PCI.
Main Methods:
- 54 patients undergoing elective PCI were recruited.
- Index of micro-circulatory resistance (IMR) was measured in non-target vessels after target vessel PCI (cardiac RIPC).
- Microvascular resistance (Rp) was assessed after arm RIPC in single-vessel disease patients.
Main Results:
- Cardiac RIPC did not alter non-target vessel IMR (P=0.65).
- Arm RIPC did not change microvascular resistance (P=0.19).
- Coronary flow velocity remained constant in both RIPC groups.
Conclusions:
- RIPC stimuli do not affect coronary microvascular resistance in humans.
- RIPC does not alter coronary blood flow during elective PCI.
- Current RIPC protocols show no benefit for microvascular function during PCI.
Introduction:
Remote ischemic preconditioning (RIPC) may limit myocardial infarction by improving microvascular function and maintaining myocardial blood flow. We hypothesized that a RIPC stimulus would reduce coronary microvascular resistance and improve coronary blood flow during elective percutaneous coronary intervention (PCI).
Method:
We prospectively recruited 54 patients with multi-vessel disease (MVD = 32) or single vessel disease awaiting elective PCI. Patients with MVD had non-target vessel (NTV) index of micro-circulatory resistance (IMR) determined, before and after target vessel (TV) PCI (cardiac RIPC). The effect of arm RIPC on serial microvascular resistance (R(p)) was assessed in patients with single vessel disease.
Results:
TV balloon occlusion did not alter the NTV IMR: 16.5 (12.4) baseline vs. 17.6 (11.6) post cardiac RIPC, P = 0.65 or hyperaemic transit time. Arm RIPC did not alter R( p) in patients with single vessel disease: Rp, mmHg.cm(-1).s( -1): 3.5 (1.9) baseline vs. 4.1 (3.0) post arm RIPC, P = 0.19 and coronary flow velocity remained constant.
Conclusion:
RIPC stimuli during elective PCI do not affect coronary microvascular resistance or coronary flow in humans.
