Long-term, regular remote ischemic preconditioning improves endothelial function in patients with coronary heart disease

Braz J Med Biol Res. 2015 Jun;48(6):568-76. doi: 10.1590/1414-431X20144452. Epub 2015 Apr 28.

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.

Publication types

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

MeSH terms

  • Aged
  • Antigens, CD34 / analysis
  • Blotting, Western
  • Coronary Artery Bypass / methods
  • Coronary Disease / physiopathology*
  • Coronary Disease / prevention & control*
  • Coronary Disease / surgery
  • Endothelial Progenitor Cells
  • Endothelium, Vascular / physiopathology*
  • Female
  • Flow Cytometry / methods
  • Humans
  • Immunohistochemistry
  • Ischemic Preconditioning, Myocardial / methods*
  • Leukocyte Count
  • Male
  • Middle Aged
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / prevention & control
  • Nitric Oxide Synthase Type III / analysis
  • Real-Time Polymerase Chain Reaction
  • STAT3 Transcription Factor / analysis
  • Statistics, Nonparametric
  • Time Factors
  • Treatment Outcome

Substances

  • Antigens, CD34
  • STAT3 Transcription Factor
  • Nitric Oxide Synthase Type III