Kono Yasushi, Fukuda Shota, Hanatani Akihisa, Nakanishi Koki, Otsuka Kenichiro, Taguchi Haruyuki, Shimada Kenei
Department of Medicine, Osaka Ekisaikai Hospital, Osaka, Japan.
Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Osaka, Japan.
Drug Des Devel Ther. 2014 Aug 27;8:1175-81. doi: 10.2147/DDDT.S68715. eCollection 2014.
Remote ischemic conditioning (RIC) is a treatment modality that suppresses inflammation and improves endothelial function, which are factors involved in the pathogenesis of heart failure (HF) with reduced left ventricular ejection fraction. Coronary flow reserve (CFR) is a physiological index of coronary microcirculation and is noninvasively measured by transthoracic Doppler echocardiography (TTDE). This study aimed to investigate the effects of RIC on CFR in healthy subjects and patients with HF, through the assessment by TTDE.
Ten patients with HF with left ventricular ejection fraction of less than 40%, and ten healthy volunteers were enrolled in this study. RIC treatment was performed twice a day for 1 week. Our custom-made RIC device was programmed to automatically conduct 4 cycles of 5 minutes inflation and 5 minutes deflation of a blood pressure cuff to create intermittent arm ischemia. CFR measurements and laboratory tests were examined before, and after 1 week of RIC treatment.
One week of RIC treatment was well tolerated in both groups. RIC treatment increased CFR from 4.0 ± 0.9 to 4.6 ± 1.3 (mean ± standard deviation) in healthy subjects (P=0.02), and from 1.9 ± 0.4 to 2.3 ± 0.7 in patients with HF (P = 0.03), respectively. Systolic blood pressure in healthy subjects, and heart rate in HF patients decreased after RIC treatment (both P<0.01).
This study demonstrated that a 1 week course of RIC treatment improved coronary microcirculation in healthy subjects and patients with HF associated with reduced left ventricular ejection fraction.
远程缺血预处理（RIC）是一种抑制炎症并改善内皮功能的治疗方式，而炎症和内皮功能是左心室射血分数降低的心力衰竭（HF）发病机制中的相关因素。冠状动脉血流储备（CFR）是冠状动脉微循环的生理指标，可通过经胸多普勒超声心动图（TTDE）进行无创测量。本研究旨在通过TTDE评估RIC对健康受试者和HF患者CFR的影响。
本研究纳入了10例左心室射血分数低于40%的HF患者和10名健康志愿者。RIC治疗每天进行两次，持续1周。我们定制的RIC设备被编程为自动进行4个周期的血压袖带充气5分钟和放气5分钟，以造成间歇性手臂缺血。在RIC治疗前和治疗1周后进行CFR测量和实验室检查。
两组对1周的RIC治疗耐受性良好。RIC治疗使健康受试者的CFR从4.0±0.9增加到4.6±1.3（平均值±标准差）（P=0.02），使HF患者的CFR从1.9±0.4增加到2.3±0.7（P = 0.03）。RIC治疗后，健康受试者的收缩压和HF患者的心率均下降（均P<0.01）。
本研究表明，为期1周的RIC治疗改善了健康受试者和与左心室射血分数降低相关的HF患者的冠状动脉微循环。
