Background Ischemic preconditioning results in a reduction in ischemic-reperfusion injury to the heart. This beneficial effect is seen both with direct local preconditioning of the myocardium and with remote preconditioning of easily accessible distant non-vital limb tissue. Ischemic postconditioning with a comparable sequence of brief periods of local ischemia, when applied immediately after the ischemic insult, confers similar benefits to preconditioning. The present study tested the hypothesis that limb ischemia induces remote postconditioning and hence reduces experimental myocardial infarct size in a validated swine model of acute myocardial infarction (AMI).
Methods and Results AMI was induced in 24 pigs with 90-minute balloon inflations of the left anterior descending coronary artery. Remote ischemic postconditioning was induced in 12 of the pigs by four 5-minute cycles of blood pressure cuff inflation applied to the lower limb immediately after the balloon deflation. Infarct size was assessed by measuring 72 hour creatinine kinase release, MRI scan and immunohistochemistry. Area under the curve of creatinine kinase release was significantly reduced in the postconditioning compared with the control group with a 26% reduction in infarct size (p<0.05). This was confirmed by MRI scanning and immunohistochemistry that revealed a 22 % (p<0.05) and a 47.52 % (p<0.01) relative reduction in infarct size respectively.
Conclusion Remote ischemic postconditioning represents a simple technique to reduce infarct size without the hazards and logistics of multiple coronary artery balloon inflations. Remote ischemic postconditioning promises clear clinical potential.
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