TY - JOUR
TI - Vascular conditioning prevents adverse left ventricular remodelling after acute myocardial infarction: a randomised remote conditioning study
AU - Ikonomidis, I.
AU - Vlastos, D.
AU - Andreadou, I.
AU - Gazouli, M.
AU - Efentakis, P.
AU - Varoudi, M.
AU - Makavos, G.
AU - Kapelouzou, A.
AU - Lekakis, J.
AU - Parissis, J.
AU - Katsanos, S.
AU - Tsilivarakis, D.
AU - Hausenloy, D.J.
AU - Alexopoulos, D.
AU - Cokkinos, D.V.
AU - Bøtker, H.-E.
AU - Iliodromitis, E.K.
JO - Basic Research in Cardiology
PY - 2021
VL - 116
TODO - 1
SP - null
PB - Springer Science and Business Media Deutschland GmbH
SN - 0300-8428, 1435-1803
TODO - 10.1007/s00395-021-00851-1
TODO - acetylsalicylic acid;  beta adrenergic receptor blocking agent;  clopidogrel;  dipeptidyl carboxypeptidase inhibitor;  enoxaparin;  heparin;  hydroxymethylglutaryl coenzyme A reductase inhibitor;  malonaldehyde;  microRNA;  miR 144;  miR 150;  miR 208;  miR 21;  nitrate;  nitrite;  unclassified drug;  autacoid;  circulating microRNA;  microRNA, acute heart infarction;  adult;  arterial stiffness;  Article;  carotid-femoral pulse wave velocity;  controlled study;  female;  glycocalyx;  heart left ventricle endsystolic volume;  heart left ventricle volume;  heart ventricle remodeling;  human;  major clinical study;  male;  oxidative stress;  percutaneous coronary intervention;  randomized controlled trial;  remote ischemic conditioning;  ST segment elevation myocardial infarction;  adverse event;  aged;  artery;  blood;  blood flow;  diagnostic imaging;  endothelium cell;  Greece;  heart left ventricle function;  ischemic postconditioning;  metabolism;  middle aged;  myocardial ischemia reperfusion injury;  pathophysiology;  percutaneous coronary intervention;  prospective study;  time factor;  treatment outcome;  upper limb;  vascularization, Adult;  Aged;  Arteries;  Circulating MicroRNA;  Endothelial Cells;  Female;  Glycocalyx;  Greece;  Humans;  Inflammation Mediators;  Ischemic Postconditioning;  Male;  MicroRNAs;  Middle Aged;  Myocardial Reperfusion Injury;  Oxidative Stress;  Percutaneous Coronary Intervention;  Prospective Studies;  Regional Blood Flow;  ST Elevation Myocardial Infarction;  Time Factors;  Treatment Outcome;  Upper Extremity;  Vascular Stiffness;  Ventricular Function, Left;  Ventricular Remodeling
TODO - Aims: Remote ischemic conditioning (RIC) alleviates ischemia–reperfusion injury via several pathways, including micro-RNAs (miRs) expression and oxidative stress modulation. We investigated the effects of RIC on endothelial glycocalyx, arterial stiffness, LV remodelling, and the underlying mediators within the vasculature as a target for protection. Methods and results: We block-randomised 270 patients within 48 h of STEMI post-PCI to either one or two cycles of bilateral brachial cuff inflation, and a control group without RIC. We measured: (a) the perfusion boundary region (PBR) of the sublingual arterial microvessels to assess glycocalyx integrity; (b) the carotid-femoral pulse wave velocity (PWV); (c) miR-144,-150,-21,-208, nitrate-nitrite (NOx) and malondialdehyde (MDA) plasma levels at baseline (T0) and 40 min after RIC onset (T3); and (d) LV volumes at baseline and after one year. Compared to baseline, there was a greater PBR and PWV decrease, miR-144 and NOx levels increase (p < 0.05) at T3 following single- than double-cycle inflation (PBR:ΔT0–T3 = 0.249 ± 0.033 vs 0.126 ± 0.034 μm, p = 0.03 and PWV:0.4 ± 0.21 vs −1.02 ± 0.24 m/s, p = 0.03). Increased miR-150,-21,-208 (p < 0.05) and reduced MDA was observed after both protocols. Increased miR-144 was related to PWV reduction (r = 0.763, p < 0.001) after the first-cycle inflation in both protocols. After one year, single-cycle RIC was associated with LV end-systolic volume reduction (LVESV) > 15% (odds-ratio of 3.75, p = 0.029). MiR-144 and PWV changes post-RIC were interrelated and associated with LVESV reduction at follow-up (r = 0.40 and 0.37, p < 0.05), in the single-cycle RIC. Conclusion: RIC evokes “vascular conditioning” likely by upregulation of cardio-protective microRNAs, NOx production, and oxidative stress reduction, facilitating reverse LV remodelling. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT03984123. © 2021, Springer-Verlag GmbH, DE part of Springer Nature.
ER -