Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Puusepa 8, Tartu 50406, Estonia.
Heart Clinic, Tartu University Hospital, Puusepa 8, Tartu 50406, Estonia.
Oxid Med Cell Longev. 2021 Dec 8;2021:6043550. doi: 10.1155/2021/6043550. eCollection 2021.
Diagnostic digital subtraction angiography (DSA) and DSA with percutaneous transluminal angioplasty (DSA-PTA) are common procedures for diagnosing and treating symptomatic lower extremity arterial disease (LEAD). However, organ damage following DSA and DSA-PTA is often underrecognised and hence undiagnosed. To reduce the risk induced by invasive procedures in symptomatic LEAD patients, the method of remote ischemic preconditioning (RIPC) has been suggested. The aim of the current study was to assess the effect of RIPC intervention on the organ damage markers profile, oxidative stress, and inflammation biomarkers in LEAD patients undergoing DSA and DSA-PTA procedure.
The RIPC intervention was performed by inflating a standard blood pressure cuff on the patient's upper arm to 200 mmHg for 5 minutes four times with 5-minute perfusion between each cycle. The sham intervention was performed similarly, but the cuff was inflated to 20 mmHg. Changes in the cardiac and renal damage biomarkers' profile, oxidative stress, and inflammation biomarkers were recorded before and 24 hours after DSA or DSA-PTA.
A total of 111 (RIPC 54, sham 57) patients with symptomatic LEAD scheduled for endovascular procedure were randomised, and 102 patients (RIPC 47, sham 55) completed the study protocol. RIPC significantly limited the increase of adiponectine levels after DSA and DSA-PTA, compared to sham intervention ( = 0.020), but CK-MB levels were markedly lower in the sham group ( = 0.047) after procedure. There was no significant difference between the RIPC and the sham group in mean changes in hs-troponin-T ( = 0.25), NT-proBNP ( = 0.24), creatinine ( = 0.76), eGFR ( = 0.61), urea ( = 0.95), beta-2-microglobuline ( = 0.34), or cystatine C ( = 0.24) levels.
In this controlled clinical study, RIPC failed to improve the profile of renal and cardiac biomarkers in patients with LEAD periprocedurally. RIPC significantly limits the rise in adiponectin levels and may influence the decrease of CK-MB levels 24 hours after endovascular procedure.
诊断性数字减影血管造影（DSA）和经皮腔内血管成形术（DSA-PTA）是诊断和治疗有症状下肢动脉疾病（LEAD）的常见方法。然而，DSA 和 DSA-PTA 后的器官损伤往往未被认识到，因此也未被诊断出来。为了降低有症状的 LEAD 患者介入性操作的风险，已经提出了远程缺血预处理（RIPC）的方法。本研究的目的是评估 RIPC 干预对接受 DSA 和 DSA-PTA 操作的 LEAD 患者的器官损伤标志物谱、氧化应激和炎症生物标志物的影响。
RIPC 干预通过将标准血压袖带充气至患者上臂 200mmHg 5 分钟，每个循环之间进行 5 分钟灌注，共进行 4 次。假干预以类似的方式进行，但袖带充气至 20mmHg。记录 DSA 或 DSA-PTA 前后 24 小时心脏和肾脏损伤标志物谱、氧化应激和炎症生物标志物的变化。
共有 111 名（RIPC 54 例，假干预 57 例）有症状的 LEAD 患者计划进行血管内操作，其中 102 名（RIPC 47 例，假干预 55 例）完成了研究方案。与假干预相比，RIPC 显著限制了 DSA 和 DSA-PTA 后脂联素水平的升高（=0.020），但在术后 sham 组中 CK-MB 水平明显降低（=0.047）。RIPC 组和 sham 组间 hs-troponin-T（=0.25）、NT-proBNP（=0.24）、肌酐（=0.76）、eGFR（=0.61）、尿素（=0.95）、β2-微球蛋白（=0.34）或胱抑素 C（=0.24）水平的平均变化无显著差异。
在这项对照临床试验中，RIPC 未能改善 LEAD 患者围手术期的肾脏和心脏生物标志物谱。RIPC 显著限制了脂联素水平的升高，并可能影响血管内操作后 24 小时 CK-MB 水平的降低。
