Remote Ischemic Conditioning in Patients With Myocardial Infarction Treated With Primary Angioplasty: Impact on Left Ventricular Function Assessed by Comprehensive Echocardiography and Gated Single-Photon Emission CT

Circ Cardiovasc Imaging. 2010 Nov;3(6):656-62. doi: 10.1161/CIRCIMAGING.110.957340. Epub 2010 Sep 8.


Background: we have found that remote ischemic conditioning (rIC), adjunctive to primary angioplasty, increases myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) and extensive myocardial area at risk (AAR). The present substudy aimed to evaluate the short-term effects of rIC on left ventricular (LV) function.

Methods and results: patients with a first STEMI were randomized to rIC (4 cycles of 5 minutes upper-limb ischemia) during transfer to primary percutaneous coronary intervention (pPCI) (n=123) versus pPCI alone (n=119). Ejection fraction (EF), LV volumes, (2D and 3D echocardiography and myocardial perfusion imaging), and speckle-tracking global longitudinal strain were compared between treatment groups. There was no significant difference in LV function at day 1 (EF-2D, 0.51±0.10 versus 0.49±0.10; P=0.22) and after 30 days (EF-2D, 0.54±0.08 versus 0.53±0.10) between the rIC and the pPCI-alone groups. In patients with extensive AAR ≥35% of LV (n=53), EF after 30 days was higher after rIC than after pPCI alone (EF-2D, 0.51±0.07 versus 0.46±0.09; P=0.05). In patients with anterior infarction (n=97), rIC preserved LV function on day 1 (EF-2D, 0.51±0.11 versus 0.46±0.11; P=0.03) and persistently after 30 days (EF-2D, 0.55±0.08 versus 0.50±0.11; P=0.04; EF-myocardial perfusion imaging, 0.55±0.10 versus 0.49±0.12; P=0.02). These patients had similar AAR, whereas rIC reduced infarct size from 16% to 7% of LV (P=0.01).

Conclusions: although no significant overall effect was observed, rIC seemed to result in modest improvement in LV function in high-risk patients prone to develop large myocardial infarcts. These results need to be confirmed in larger trials.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angioplasty, Balloon, Coronary / methods*
  • Cohort Studies
  • Echocardiography, Three-Dimensional / methods*
  • Female
  • Heart Ventricles / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications
  • Myocardial Infarction / therapy*
  • Myocardial Perfusion Imaging / methods
  • Myocardial Reperfusion Injury / diagnosis
  • Myocardial Reperfusion Injury / etiology
  • Observer Variation
  • Reproducibility of Results
  • Risk Factors
  • Tomography, Emission-Computed, Single-Photon / methods*
  • Treatment Outcome
  • Ventricular Dysfunction, Left / diagnosis*
  • Ventricular Dysfunction, Left / etiology*
  • Ventricular Remodeling*