The effect of Remote Ischemic Preconditioning (RIPC) on myocardial injury and inflammation in patients with severe aortic valve stenosis undergoing Transcatheter Aortic Valve Replacement (TAVΙ)

Antonios Halapas; Alkistis Kapelouzou; Michael Chrissoheris; Gregory Pattakos; Dennis V Cokkinos; Konstantinos Spargias

doi:10.1016/j.hjc.2021.02.003

The effect of Remote Ischemic Preconditioning (RIPC) on myocardial injury and inflammation in patients with severe aortic valve stenosis undergoing Transcatheter Aortic Valve Replacement (TAVΙ)

Hellenic J Cardiol. 2021 Nov-Dec;62(6):423-428. doi: 10.1016/j.hjc.2021.02.003. Epub 2021 Feb 20.

Authors

Antonios Halapas¹, Alkistis Kapelouzou², Michael Chrissoheris³, Gregory Pattakos³, Dennis V Cokkinos², Konstantinos Spargias³

Affiliations

¹ THV Department, Heart Team Hygeia Hospital Athens Greece, Er. Stavrou 9, Marousi, Athens, Greece. Electronic address: ahalapas@gmail.com.
² Center of Clinical, Experimental Surgery, & Translation Research, Biomedical Research Foundation Academy of Athens (BRFAA), Soranou Efesiou 4, 11527, Athens, Greece.
³ THV Department, Heart Team Hygeia Hospital Athens Greece, Er. Stavrou 9, Marousi, Athens, Greece.

PMID: 33617961
DOI: 10.1016/j.hjc.2021.02.003

Abstract

Background: Remote ischemic preconditioning (RIPC) is being evaluated as a strategy to reduce cardiac injury and inflammation in patients undergoing diverse cardiac invasive and surgical procedures. However, it is unclear whether RIPC has protective effects in patients undergoing the transfemoral- transcatheter aortic valve implantation (TF-TAVΙ) procedure.

Methods: Between September 2013 and September 2015, 55 random consecutive patients were prospectively assigned to receive SHAM preconditioning (SHAM, 22 patients) or Remote Ischemic Preconditioning (RIPC) (4 cycles of 5 min intermittent leg ischemia and 5 min reperfusion, 33 patients) prior to TF-TAVI. The primary endpoint was to determine the serum levels of: hs-cTn-I (necrosis), CK-18 (apoptosis), and IL-1b (inflammation). Quantification was performed using commercially available ELISA kits. Patients were sampled 1-day pre TF-TAVΙ and 24-hours post TF-TAVΙ. Secondary endpoints included: total mortality, incidence of periprocedural clinical acute myocardial infarction (AMI), acute kidney injury (AKI), and stroke.

Results: 22 SHAM patients and 33 RIPC patients were finally analyzed. Our data revealed no significant difference in serum levels of hs-cTn-I and CK-18 among various groups. However, in the RIPC group, the increase in IL1b level was significantly lower for 24-h post TF-TAVΙ, (p < 0.01). There were no significant differences between groups in the secondary endpoints at the follow-up interval of one month. RIPC-related adverse events were not observed.

Conclusions: Our data suggest that RIPC did not exhibit significant cardiac or kidney protective effects regarding necrosis and apoptosis in patients undergoing TF-TAVΙ. However, an important anti-inflammatory effect was detected in the RIPC group.

Keywords: aortic valve stenosis; inflammatory cytokines; myocardial lesion; remote ischemic preconditioning; transcatheter aortic valve replacement.

Publication types

Randomized Controlled Trial

MeSH terms

Aortic Valve Stenosis* / surgery
Humans
Inflammation / prevention & control
Ischemic Preconditioning*
Ischemic Preconditioning, Myocardial*
Myocardial Infarction*
Transcatheter Aortic Valve Replacement* / adverse effects