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Effects of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: A Randomised Clinical Trial.
Eur J Vasc Endovasc Surg. 2019 Dec; 58(6):875-882.EJ

Abstract

OBJECTIVES

Remote ischaemic preconditioning (RIPC) is a phenomenon that promotes protection of tissues and organs against ischaemia reperfusion injury. RIPC has been shown to reduce myocardial and renal injury but its effect on arterial stiffness in patients undergoing lower limb digital subtraction angiography (DSA) is unknown. The aim of this study was to evaluate the effect of RIPC on arterial stiffness in patients with peripheral arterial disease (PAD) undergoing lower limb DSA.

METHODS

In the RIPC intervention, the blood pressure cuff on the arm was inflated to 200 mmHg or to 20 mmHg above systolic pressure, and in the sham intervention to 20 mmHg. For both, the procedure was repeated for four five minute cycles at five minute intervals between the cycles. Changes in heart rate corrected augmentation index (AIx@75), augmentation index (AIx), carotid femoral pulse wave velocity (PWV), and haemodynamic parameters were measured before and 24 h after DSA.

RESULTS

111 (RIPC 54, sham 57) patients with symptomatic lower limb PAD scheduled for DSA were randomised. 102 patients (RIPC 47, sham 55) were included in final analysis. RIPC significantly improved AIx (-5.46% in RIPC and -1.45% in sham group; p = .05), but not AIx@75 (-4.88% in RIPC and -1.38% in sham group; p = .07) or PWV (-0.41 m/s in RIPC and -0.27 m/s in sham group; p = .74). In the RIPC group a significant reduction in AIx (p = .002) and AIx@75 (p = .003) was noted after stenting when compared with the sham intervention. AIx (p = .001), AIx@75 (p = .002), mean arterial (p = .01), peripheral (p = .02), and central systolic blood pressure (p = .006) were significantly reduced only in the RIPC group 24 h after DSA.

CONCLUSION

This study evaluates for the first time the effects of RIPC on arterial stiffness parameters in patients with symptomatic PAD following DSA. RIPC may modulate arterial stiffness following a DSA procedure and is more pronounced in patients after stent placement.

Authors+Show Affiliations

Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Heart Clinic, Tartu University Hospital, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia. Electronic address: karl.kuusik@kliinikum.ee.Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia.Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Heart Clinic, Tartu University Hospital, Tartu, Estonia.Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia.Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Vascular Surgery, Surgery Clinic, Tartu University Hospital, Tartu, Estonia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31648881

Citation

Kuusik, Karl, et al. "Effects of Remote Ischaemic Preconditioning On Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: a Randomised Clinical Trial." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 58, no. 6, 2019, pp. 875-882.
Kuusik K, Kepler T, Zilmer M, et al. Effects of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: A Randomised Clinical Trial. Eur J Vasc Endovasc Surg. 2019;58(6):875-882.
Kuusik, K., Kepler, T., Zilmer, M., Eha, J., Vähi, M., & Kals, J. (2019). Effects of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: A Randomised Clinical Trial. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 58(6), 875-882. https://doi.org/10.1016/j.ejvs.2019.06.004
Kuusik K, et al. Effects of Remote Ischaemic Preconditioning On Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: a Randomised Clinical Trial. Eur J Vasc Endovasc Surg. 2019;58(6):875-882. PubMed PMID: 31648881.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: A Randomised Clinical Trial. AU - Kuusik,Karl, AU - Kepler,Teele, AU - Zilmer,Mihkel, AU - Eha,Jaan, AU - Vähi,Mare, AU - Kals,Jaak, Y1 - 2019/10/21/ PY - 2019/01/30/received PY - 2019/05/09/revised PY - 2019/06/09/accepted PY - 2019/10/28/pubmed PY - 2019/10/28/medline PY - 2019/10/26/entrez KW - Angiography KW - Digital subtraction KW - Endovascular procedures KW - Ischaemic preconditioning KW - Peripheral arterial disease KW - Pulse wave analysis KW - Vascular stiffness SP - 875 EP - 882 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 58 IS - 6 N2 - OBJECTIVES: Remote ischaemic preconditioning (RIPC) is a phenomenon that promotes protection of tissues and organs against ischaemia reperfusion injury. RIPC has been shown to reduce myocardial and renal injury but its effect on arterial stiffness in patients undergoing lower limb digital subtraction angiography (DSA) is unknown. The aim of this study was to evaluate the effect of RIPC on arterial stiffness in patients with peripheral arterial disease (PAD) undergoing lower limb DSA. METHODS: In the RIPC intervention, the blood pressure cuff on the arm was inflated to 200 mmHg or to 20 mmHg above systolic pressure, and in the sham intervention to 20 mmHg. For both, the procedure was repeated for four five minute cycles at five minute intervals between the cycles. Changes in heart rate corrected augmentation index (AIx@75), augmentation index (AIx), carotid femoral pulse wave velocity (PWV), and haemodynamic parameters were measured before and 24 h after DSA. RESULTS: 111 (RIPC 54, sham 57) patients with symptomatic lower limb PAD scheduled for DSA were randomised. 102 patients (RIPC 47, sham 55) were included in final analysis. RIPC significantly improved AIx (-5.46% in RIPC and -1.45% in sham group; p = .05), but not AIx@75 (-4.88% in RIPC and -1.38% in sham group; p = .07) or PWV (-0.41 m/s in RIPC and -0.27 m/s in sham group; p = .74). In the RIPC group a significant reduction in AIx (p = .002) and AIx@75 (p = .003) was noted after stenting when compared with the sham intervention. AIx (p = .001), AIx@75 (p = .002), mean arterial (p = .01), peripheral (p = .02), and central systolic blood pressure (p = .006) were significantly reduced only in the RIPC group 24 h after DSA. CONCLUSION: This study evaluates for the first time the effects of RIPC on arterial stiffness parameters in patients with symptomatic PAD following DSA. RIPC may modulate arterial stiffness following a DSA procedure and is more pronounced in patients after stent placement. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/31648881/Effects_of_Remote_Ischaemic_Preconditioning_on_Arterial_Stiffness_in_Patients_Undergoing_Lower_Limb_Angiographic_Procedures:_A_Randomised_Clinical_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(19)30494-0 DB - PRIME DP - Unbound Medicine ER -
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