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Long-term, regular remote ischemic preconditioning improves endothelial function in patients with coronary heart
1Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Insights
Long-term remote ischemic preconditioning (RIPre) significantly improves arterial endothelial function in patients with coronary heart disease (CHD). This intervention, involving repeated blood flow occlusion and reperfusion, enhances flow-mediated dilation and increases endothelial progenitor cells.
Area of Science:
- Cardiovascular Research
- Vascular Biology
- Regenerative Medicine
Background:
- Coronary artery disease (CHD) is a leading cause of mortality.
- Endothelial dysfunction is a key factor in CHD pathogenesis.
- Remote ischemic preconditioning (RIPre) shows potential for cardioprotection.
Purpose of the Study:
- To evaluate the long-term effects of regular RIPre on human arterial endothelial function.
- To investigate the impact of RIPre on endothelial progenitor cells and underlying molecular mechanisms in patients with CHD.
Main Methods:
- Forty patients undergoing coronary artery bypass graft (CABG) surgery were randomized into RIPre and CHD groups (n=20 each).
- A control group (n=20) of mastectomy patients was included.
- RIPre involved cycles of 5-minute arterial occlusion followed by 5-minute reperfusion, repeated 4 times, 3 times daily for 20 days.
- Endothelial function (flow-mediated dilation - FMD), CD34(+) monocyte count, eNOS expression, and STAT-3/Akt phosphorylation were assessed in arterial samples.
Main Results:
- Long-term RIPre significantly improved FMD in the RIPre group compared to the CHD group (8.5±2.4% vs 4.9±4.2%, P<0.05).
- Troponin levels post-CABG surgery were significantly reduced in the RIPre group.
- RIPre activated STAT-3 signaling and increased CD34(+) endothelial progenitor cell counts.
Conclusions:
- Regular, long-term RIPre enhances endothelial function in patients with CHD.
- STAT-3 activation appears to be a key mechanism mediating RIPre's benefits.
- RIPre may promote vascular repair through an increase in endothelial progenitor cells.
Abstract:
Remote ischemic preconditioning (RIPre) can prevent myocardial injury. The purpose of this study was to assess the beneficial effects of long-term regular RIPre on human arteries. Forty patients scheduled for coronary artery bypass graft (CABG) surgery were assigned randomly to a RIPre group (n=20) or coronary heart disease (CHD) group (n=20). Twenty patients scheduled for mastectomy were enrolled as a control group. RIPre was achieved by occluding arterial blood flow 5 min with a mercury sphygmomanometer followed by a 5-min reperfusion period, and this was repeated 4 times. The RIPre procedure was repeated 3 times a day for 20 days. In all patients, arterial fragments discarded during surgery were collected to evaluate endothelial function by flow-mediated dilation (FMD), CD34(+) monocyte count, and endothelial nitric oxide synthase (eNOS expression). Phosphorylation levels of STAT-3 and Akt were also assayed to explore the underlying mechanisms. Compared with the CHD group, long-term regular RIPre significantly improved FMD after 20 days (8.5±2.4 vs 4.9±4.2%, P<0.05) and significantly reduced troponin after CABG surgery (0.72±0.31 and 1.64±0.19, P<0.05). RIPre activated STAT-3 and increased CD34(+) endothelial progenitor cell counts found in arteries. Long-term, regular RIPre improved endothelial function in patients with CHD, possibly due to STAT-3 activation, and this may have led to an increase in endothelial progenitor cells.
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