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Effect of long-term remote ischemic conditioning in patients with chronic ischemic heart failure

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Abstract

Remote ischemic conditioning (RIC) protects against acute ischemia–reperfusion injury and may also have beneficial effects in patients with stable cardiovascular disease. We investigated the effect of long-term RIC treatment in patients with chronic ischaemic heart failure (CIHF). In a parallel group study, 22 patients with compensated CIHF and 21 matched control subjects without heart failure or ischemic heart disease were evaluated by cardiac magnetic resonance imaging, cardiopulmonary exercise testing, skeletal muscle function testing, blood pressure measurement and blood sampling before and after 28 ± 4 days of once daily RIC treatment. RIC was conducted as four cycles of 5 min upper arm ischemia followed by 5 min of reperfusion. RIC did not affect left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS) in patients with CIHF (p = 0.63 and p = 0.11) or matched controls (p = 0.32 and p = 0.20). RIC improved GLS in the subgroup of patients with CIHF and with NT-proBNP plasma levels above the geometric mean of 372 ng/l (p = 0.04). RIC did not affect peak workload or oxygen uptake in either patients with CIHF (p = 0.26 and p = 0.59) or matched controls (p = 0.61 and p = 0.10). However, RIC improved skeletal muscle power in both groups (p = 0.02 for both). In patients with CIHF, RIC lowered systolic blood pressure (p < 0.01) and reduced NT-proBNP plasma levels (p = 0.02). Our findings suggest that long-term RIC treatment does not improve LVEF but increases skeletal muscle function and reduces blood pressure and NT-proBNP in patients with compensated CIHF. This should be investigated in a randomized sham-controlled trial.

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Abbreviations

CIHF:

Chronic ischemic heart failure

GLS:

Global longitudinal strain

CMR:

Cardiac magnetic resonance

LVEF:

Left ventricular ejection fraction

MLWHFQ:

Minnesota Living with Heart Failure Questionnaire

NT-proBNP:

N-terminal pro-brain natriuretic peptide

RIC:

Remote ischemic conditioning

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Acknowledgements

We thank Casper Carlson Elkjær and Anja Helveg Larsen from Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark, and Maria Krejberg Skou and Dagmar Margrethe Lybæk Sieg from Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark for technical assistance.

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Authors and Affiliations

  1. Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark

    Kasper Pryds, Roni Ranghøj Nielsen, Anders Jorsal, Mona Sahlholdt Hansen, Won Yong Kim, Hans Erik Bøtker & Michael Rahbek Schmidt

  2. Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Kasper Pryds

  3. MR Centre, Aarhus University, Aarhus, Denmark

    Steffen Ringgaard & Won Yong Kim

  4. Department of Cardiology, Viborg Region Hospital, Viborg, Denmark

    Roni Ranghøj Nielsen & Jens Refsgaard

  5. Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark

    Annemette Krintel Petersen

  6. Department of Clinical Medicine and Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Aarhus, Denmark

    Annemette Krintel Petersen

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  1. Kasper Pryds
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  2. Roni Ranghøj Nielsen
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  9. Hans Erik Bøtker
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  10. Michael Rahbek Schmidt
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Contributions

KP, RRN, HEB, and MRS designed the experiments. KP did the data analysis and drafting of the manuscript. All authors participated in data acquisition and critical revision of the manuscript.

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Correspondence to Kasper Pryds.

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Funding

This study was funded by The Danish Council for Strategic Research (11-115818), Kirsten Anthonius’ Mindelegat, The Danish Heart Foundation, Direktør Kurt Bønnelycke og hustru fru Grethe Bønnelyckes Fond and The Novo Nordisk Foundation Interdisciplinary Synergi Programme. The study was designed, conducted, analyzed, interpreted, and reported independently of all funding sources.

Conflict of interest

HEB and MRS are shareholders in CellAegis Devices Inc. KP, RRN, AJ, MSH, SR, JR, WYK, and AKP declare that they have no conflict of interest.

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Pryds, K., Nielsen, R.R., Jorsal, A. et al. Effect of long-term remote ischemic conditioning in patients with chronic ischemic heart failure. Basic Res Cardiol 112, 67 (2017). https://doi.org/10.1007/s00395-017-0658-6

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