Top

Published in:

01-06-2018 | Original Article

Effect of remote ischemic conditioning on myocardial perfusion in patients with suspected ischemic coronary artery disease

Authors: Kasper Pryds, MD, Roni Ranghøj Nielsen, MD, PhD, Camilla Molich Hoff, MD, PhD, Lars Poulsen Tolbod, MSc, PhD, Kirsten Bouchelouche, MD, DMSc, Jing Li, PhD, Michael Rahbek Schmidt, MD, PhD, Andrew N. Redington, MD, Jørgen Frøkiær, MD, DMSc, Hans Erik Bøtker, MD, PhD, DMSc

Published in: Journal of Nuclear Cardiology | Issue 3/2018

Abstract

Background

Remote ischemic conditioning (RIC) confers protection against myocardial ischemia-reperfusion injury and may modulate coronary blood flow. We investigated whether RIC affects resting myocardial perfusion (MP) in patients with suspected ischemic coronary artery disease by quantitative MP imaging.

Methods and Results

We included 49 patients with suspected ischemic coronary artery disease. Resting MP was quantified by ⁸²Rubidium positron emission tomography/computed tomography (⁸²Rb-PET/CT) imaging before and after RIC, performed as four cycles of 5 minutes upper arm ischemia and reperfusion. Subsequent adenosine ⁸²Rb-PET/CT stress-imaging identified non-ischemic and reversibly ischemic myocardial segments. MicroRNA-144 plasma levels were measured before and after RIC. Normalized for rate pressure product, RIC did not affect MP globally (P = .64) or in non-ischemic myocardial segments (P = .58) but decreased MP in reversibly ischemic myocardial segments (−0.11 mL/min/g decrease in MP following RIC; 95% CI −0.17 to −0.06, P < .001). However, we found no effect of RIC when MP was normalized for cardiac work. MicroRNA-144 plasma levels increased following RIC (P = .006) but did not correlate with a change in global MP in response to RIC (P = .40).

Conclusions

RIC did not substantially affect resting MP globally or in non-ischemic and reversibly ischemic myocardial territories in patients with suspected ischemic coronary artery disease.

Available only for authorised users

Heusch G, Botker HE, Przyklenk K, Redington A, Yellon D. Remote ischemic conditioning. J Am Coll Cardiol 2015;65:177–95.CrossRefPubMedPubMedCentral

Heusch G. Molecular basis of cardioprotection: Signal transduction in ischemic pre-, post-, and remote conditioning. Circ Res 2015;116:674–99.CrossRefPubMed

Kharbanda RK, Mortensen UM, White PA, Kristiansen SB, Schmidt MR, Hoschtitzky JA, et al. Transient limb ischemia induces remote ischemic preconditioning in vivo. Circulation 2002;106:2881–3.CrossRefPubMed

Heusch G. The coronary circulation as a target of cardioprotection. Circ Res 2016;118:1643–58.CrossRefPubMed

Konstantinov IE, Arab S, Kharbanda RK, Li J, Cheung MM, Cherepanov V, et al. The remote ischemic preconditioning stimulus modifies inflammatory gene expression in humans. Physiol Genom 2004;19:143–50.CrossRef

Shimizu M, Konstantinov IE, Kharbanda RK, Cheung MH, Redington AN. Effects of intermittent lower limb ischaemia on coronary blood flow and coronary resistance in pigs. Acta Physiol (Oxf) 2007;190:103–9.CrossRef

Zhou K, Yang B, Zhou XM, Tan CM, Zhao Y, Huang C, et al. Effects of remote ischemic preconditioning on the flow pattern of the left anterior descending coronary artery in normal subjects. Int J Cardiol 2007;122:250–1.CrossRefPubMed

Kono Y, Fukuda S, Hanatani A, Nakanishi K, Otsuka K, Taguchi H, et al. Remote ischemic conditioning improves coronary microcirculation in healthy subjects and patients with heart failure. Drug Design Dev Therapy 2014;8:1175–81.

Li J, Rohailla S, Gelber N, Rutka J, Sabah N, Gladstone RA, et al. MicroRNA-144 is a circulating effector of remote ischemic preconditioning. Basic Res Cardiol 2014;109:423.CrossRefPubMed

10.

Lortie M, Beanlands RS, Yoshinaga K, Klein R, Dasilva JN, DeKemp RA. Quantification of myocardial blood flow with 82Rb dynamic PET imaging. Eur J Nucl Med Mol Imaging 2007;34:1765–74.CrossRefPubMed

11.

Harms HJ, Knaapen P, de Haan S, Halbmeijer R, Lammertsma AA, Lubberink M. Automatic generation of absolute myocardial blood flow images using [15O]H₂O and a clinical PET/CT scanner. Eur J Nucl Med Mol Imaging 2011;38:930–9.CrossRefPubMedPubMedCentral

12.

Czernin J, Muller P, Chan S, Brunken RC, Porenta G, Krivokapich J, et al. Influence of age and hemodynamics on myocardial blood flow and flow reserve. Circulation 1993;88:62–9.CrossRefPubMed

13.

Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–42.CrossRefPubMed

14.

Van Tosh A, Votaw JR, Reichek N, Palestro CJ, Nichols KJ. The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated Rb-82 PET myocardial perfusion imaging. J Nucl Cardiol 2013;20:1060–8.CrossRefPubMedPubMedCentral

15.

Naya M, Murthy VL, Taqueti VR, Foster CR, Klein J, Garber M, et al. Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography. J Nucl Med 2014;55:248–55.CrossRefPubMedPubMedCentral

16.

Spinelli L, Petretta M, Acampa W, He W, Petretta A, Bonaduce D, et al. Prognostic value of combined assessment of regional left ventricular function and myocardial perfusion by dobutamine and rest gated SPECT in patients with uncomplicated acute myocardial infarction. J Nucl Med 2003;44:1023–9.PubMed

17.

von Ziegler F, Brendel M, Uebleis C, Helbig S, Greif M, Ruemmler J, et al. SPECT myocardial perfusion imaging as an adjunct to coronary calcium score for the detection of hemodynamically significant coronary artery stenosis. BMC Cardiovasc Disor 2012;12:1.CrossRef

18.

Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) method. Methods 2001;25:402–8.CrossRefPubMed

19.

Efseaff M, Klein R, Ziadi MC, Beanlands RS, deKemp RA. Short-term repeatability of resting myocardial blood flow measurements using rubidium-82 PET imaging. J Nucl Cardiol 2012;19:997–1006.CrossRefPubMed

20.

Hoole SP, Heck PM, White PA, Khan SN, O’Sullivan M, Clarke SC, et al. Remote ischemic preconditioning stimulus does not reduce microvascular resistance or improve myocardial blood flow in patients undergoing elective percutaneous coronary intervention. Angiology 2009;60:403–11.CrossRefPubMed

21.

Salerno M, Beller GA. Noninvasive assessment of myocardial perfusion. Circ Cardiovasc Imaging 2009;2:412–24.CrossRefPubMed

22.

Ramanathan T, Skinner H. Coronary blood flow. Contin Educ Anaesth Crit Care Pain 2005;5:61–4.CrossRef

23.

Murry CE, Richard VJ, Reimer KA, Jennings RB. Ischemic preconditioning slows energy metabolism and delays ultrastructural damage during a sustained ischemic episode. Circ Res 1990;66:913–31.CrossRefPubMed

24.

Johnsen J, Pryds K, Salman R, Lofgren B, Kristiansen SB, Botker HE. The remote ischemic preconditioning algorithm: Effect of number of cycles, cycle duration and effector organ mass on efficacy of protection. Basic Res Cardiol 2016;111:10.CrossRefPubMed

25.

Prior JO, Allenbach G, Valenta I, Kosinski M, Burger C, Verdun FR, et al. Quantification of myocardial blood flow with 82Rb positron emission tomography: Clinical validation with 15O-water. Eur J Nucl Med Mol Imaging 2012;39:1037–47.CrossRefPubMedPubMedCentral

26.

Saraste A, Kajander S, Han C, Nesterov SV, Knuuti J. PET: Is myocardial flow quantification a clinical reality? J Nucl Cardiol 2012;19:1044–59.CrossRefPubMed

Title: Effect of remote ischemic conditioning on myocardial perfusion in patients with suspected ischemic coronary artery disease
Authors: Kasper Pryds, MD
Roni Ranghøj Nielsen, MD, PhD
Camilla Molich Hoff, MD, PhD
Lars Poulsen Tolbod, MSc, PhD
Kirsten Bouchelouche, MD, DMSc
Jing Li, PhD
Michael Rahbek Schmidt, MD, PhD
Andrew N. Redington, MD
Jørgen Frøkiær, MD, DMSc
Hans Erik Bøtker, MD, PhD, DMSc
Publication date: 01-06-2018
Publisher: Springer US
Published in: Journal of Nuclear Cardiology / Issue 3/2018
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-016-0709-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of remote ischemic conditioning on myocardial perfusion in patients with suspected ischemic coronary artery disease

Abstract

Background

Methods and Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods and Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Diagnostic and prognostic significance of transient ischemic dilation (TID) in myocardial perfusion imaging: A systematic review and meta-analysis

Comparison of the AHA/ACC vs ESC guidelines for management of patients with non-ST-elevation acute coronary syndromes: Are the differences clinically different?

Nuclear cardiology in the literature: A selection of recent, original research papers

I-123 metaiodobenzylguanidine innervation imaging as a tool for norepinephrine transporter research: A possible application for genetic analysis in heart failure

Safety of regadenoson stress testing in patients with pulmonary hypertension

Transient ischemic dilation: An old but not obsolete marker of extensive coronary artery disease