The effects of ischemia with and without remote conditioning on hyperemia induced decline in carotid-radial pulse wave velocity.

Ischemic conditioning has long held promise for preventing ischemic-reperfusion (I-R) injury. Although a number of studies have evaluated the effects of brief repeated episodes of ischemia before a prolonged ischemic episode on the cardiovascular system using clinical endpoints, more sensitive techniques by which to measure its effects are lacking. Since endothelial function is sensitive to I-R injury, flow mediated dilation of the brachial artery has been proposed for this purpose, but has significant limitations. Hyperemia normally decreases carotid to radial pulse wave velocity (PWV). Accordingly, we sought to determine the effects of I-R injury and ischemic conditioning on the hyperemic change (Δ) in PWV. We induced hyperemia by release of arterial cuff occlusion before and after ipsilateral arm I-R injury (7.5min occlusion) in 25 healthy males, age 29±6 years. The protocol was repeated on 2 occasions in combination with either pre- or post- conditioning stimuli (3× 30s contralateral arm occlusions). Hyperemia resulted in a significant decrease (-13.7%, p<.001) before but not after prolonged ischemia (-0.88%, p=0.40). I-R along with either pre- or post-ischemic conditioning restored the PWV decline (pre: -11.0%, p<0.001; post: -9.9%, p<0.001). In conclusion, 7.5min ischemia blunts the normal PWV decline produced by hyperemia. Remote pre- and post-conditioning restores this response. This technique may be useful for the assessment of novel treatment strategies and mechanisms underlying remote pre- and post-ischemic conditioning in protecting the cardiovascular system.