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European Journal of Heart Failure 2009 11(5):497-505; doi:10.1093/eurjhf/hfp040
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Remote ischaemic pre-conditioning does not attenuate ischaemic left ventricular dysfunction in humans

Stephen P. Hoole1,2, Sadia N. Khan1,2, Paul A. White2,3, Patrick M. Heck1,2, Rajesh K. Kharbanda1, Cameron G. Densem2, Sarah C. Clarke2, Leonard M. Shapiro2, Peter M. Schofield2, Michael O'Sullivan2 and David P. Dutka1,*

1 Department of Cardiovascular Medicine, Addenbrooke's Hospital, ACCI, Level 6, Box 110, Hills Road, Cambridge CB23 3RE, UK
2 Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK
3 Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK

* Corresponding author. Tel: +44 1223 331504, Fax: +44 1223 331505, Email: dpd24{at}cam.ac.uk


  Abstract

Aims: Remote ischaemic pre-conditioning (RIPC) reduces distant tissue ischaemia reperfusion injury. We tested the hypothesis that RIPC would protect the left ventricle (LV) from ischaemic dysfunction and stunning.

Methods and results: Forty-two patients with single vessel coronary disease and normal LV function were prospectively recruited. Twenty patients had repeated conductance catheter assessment of LV function during serial coronary occlusions with/without RIPC and a further 22 patients underwent serial dobutamine stress echocardiography and tissue Doppler analysis with/without RIPC. Remote ischaemic pre-conditioning was induced by three 5 min inflations of a blood pressure cuff around the upper arm. RIPC did not diminish the degree of ischaemic LV dysfunction during coronary balloon occlusion (Tau, ms: 59.2 (2.8) vs. 62.8 (2.8), P = 0.15) and there was evidence of cumulative LV dysfunction despite RIPC [ejection fraction (EF), %: 54.3 (5.8) vs. 44.9 (3.7), P = 0.03]. Remote ischaemic pre-conditioning did not improve contractile recovery during reperfusion (EF, %: 51.7 (3.6) vs. 51.5 (5.7), P = 0.88 and Tau, ms: 55.6 (2.8) vs. 56.0 (2.0), P = 0.85). A neutral effect of RIPC on LV function was confirmed by tissue Doppler analysis of ischaemic segments at peak dobutamine (Vs, cm s–1 control: 8.2 (0.4) vs. RIPC 8.1 (0.4), P = 0.43) and in recovery.

Conclusion: RIPC does not attenuate ischaemic LV dysfunction in humans.

Key Words: Coronary disease • Stunning • Ischaemic LV dysfunction • Remote ischaemic pre-conditioning

Received October 9, 2008; Revised January 25, 2009; Accepted February 6, 2009


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