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Effects of late, repetitive remote ischaemic conditioning on myocardial strain in patients with acute myocardial infarction

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journal contribution
posted on 28.07.2022, 16:24 authored by J Ranjit Arnold, Andrew P Vanezis, Glenn C Rodrigo, Florence Y Lai, Prathap Kanagala, Sheraz Nazir, Jamal N Khan, Leong Ng, Kamal Chitkara, J Gerry Coghlan, Simon Hetherington, Nilesh J Samani, Gerald P McCann
Late, repetitive or chronic remote ischaemic conditioning (CRIC) is a potential cardioprotective strategy against adverse remodelling following ST-segment elevation myocardial infarction (STEMI). In the randomised Daily Remote Ischaemic Conditioning Following Acute Myocardial Infarction (DREAM) trial, CRIC following primary percutaneous coronary intervention (P-PCI) did not improve global left ventricular (LV) systolic function. A post-hoc analysis was performed to determine whether CRIC improved regional strain. All 73 patients completing the original trial were studied (38 receiving 4 weeks’ daily CRIC, 35 controls receiving sham conditioning). Patients underwent cardiovascular magnetic resonance at baseline (5–7 days post-STEMI) and after 4 months, with assessment of LV systolic function, infarct size and strain (longitudinal/circumferential, in infarct-related and remote territories). At both timepoints, there were no significant between-group differences in global indices (LV ejection fraction, infarct size, longitudinal/circumferential strain). However, regional analysis revealed a significant improvement in longitudinal strain in the infarcted segments of the CRIC group (from − 16.2 ± 5.2 at baseline to − 18.7 ± 6.3 at follow up, p = 0.0006) but not in corresponding segments of the control group (from − 15.5 ± 4.0 to − 15.2 ± 4.7, p = 0.81; for change: − 2.5 ± 3.6 versus + 0.3 ± 5.6, respectively, p = 0.027). In remote territories, there was a lower increment in subendocardial circumferential strain in the CRIC group than in controls (− 1.2 ± 4.4 versus − 2.5 ± 4.0, p = 0.038). In summary, CRIC following P-PCI for STEMI is associated with improved longitudinal strain in infarct-related segments, and an attenuated increase in circumferential strain in remote segments. Further work is needed to establish whether these changes may translate into a reduced incidence of adverse remodelling and clinical events. Clinical Trial Registration: http://clinicaltrials.gov/show/NCT01664611.

History

Citation

Arnold, J.R., P.Vanezis, A., Rodrigo, G.C. et al. Effects of late, repetitive remote ischaemic conditioning on myocardial strain in patients with acute myocardial infarction. Basic Res Cardiol 117, 23 (2022). https://doi.org/10.1007/s00395-022-00926-7

Author affiliation

Department of Cardiovascular Sciences; NIHR Leicester Biomedical Research Centre

Version

VoR (Version of Record)

Published in

BASIC RESEARCH IN CARDIOLOGY

Volume

117

Issue

123

Publisher

SPRINGER HEIDELBERG

issn

0300-8428

eissn

1435-1803

Acceptance date

15/03/2022

Copyright date

2022

Available date

28/07/2022

Spatial coverage

Germany

Language

English