Teele Kepler1, Karl Kuusik2, Urmas Lepner3, Joel Starkopf4, Mihkel Zilmer5, Jaan Eha6, Mare Vähi7, Jaak Kals8. 1. Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia. Electronic address: Teele.Kepler@gmail.com. 2. Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia. 3. Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Tartu, Estonia. 4. Tartu University Hospital, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia. 5. Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia. 6. Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Tartu, Estonia. 7. Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia. 8. Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia; Department of Biochemistry, Institute of Biomedicine and Translational Medicine, Centre of Excellence for Genomics and Translational Medicine, University of Tartu, Tartu, Estonia; Tartu University Hospital, Tartu, Estonia.
Abstract
OBJECTIVE: The main aim of this study was to evaluate the effect of remote ischaemic preconditioning (RIPC) on preventing the leakage of cardiac damage biomarkers in patients undergoing vascular surgery. METHODS: This is a randomised, sham-controlled, double-blinded, single-centre study. Patients undergoing open abdominal aortic aneurysm repair, surgical lower limb revascularisation surgery or carotid endarterectomy were recruited non-consecutively. The RIPC protocol consisting of 4 cycles of 5 minutes of ischaemia, followed by 5 minutes of reperfusion, was applied. A RIPC or a sham procedure was performed noninvasively along with preparation for anaesthesia. High sensitivity troponin T level was measured preoperatively and 2, 8 and 24 hours after surgery and pro b-type natriuretic peptide was measured preoperatively and 24 hours after surgery. RESULTS: There was significantly higher leakage of high sensitivity troponin T (peak change median 2 ng/L, IQR 0.9-6.2 ng/L vs 0.6 ng/L, IQR 0.7-2.1 ng/L, p = .0002) and pro b-type natriuretic peptide (change median 144 pg/mL, IQR 17-318 pg/mL vs 51 pg/mL, IQR 12-196 pg/mL, p = .02) in the sham group compared to the RIPC group. CONCLUSION:RIPC reduces the leakage of high sensitivity troponin T and pro b-type natriuretic peptide. Therefore, it may offer cardioprotection in patients undergoing non-cardiac vascular surgery. The clinical significance of RIPC has to be evaluated in larger studies excluding the factors known to influence its effect.
RCT Entities:
OBJECTIVE: The main aim of this study was to evaluate the effect of remote ischaemic preconditioning (RIPC) on preventing the leakage of cardiac damage biomarkers in patients undergoing vascular surgery. METHODS: This is a randomised, sham-controlled, double-blinded, single-centre study. Patients undergoing open abdominal aortic aneurysm repair, surgical lower limb revascularisation surgery or carotid endarterectomy were recruited non-consecutively. The RIPC protocol consisting of 4 cycles of 5 minutes of ischaemia, followed by 5 minutes of reperfusion, was applied. A RIPC or a sham procedure was performed noninvasively along with preparation for anaesthesia. High sensitivity troponin T level was measured preoperatively and 2, 8 and 24 hours after surgery and pro b-type natriuretic peptide was measured preoperatively and 24 hours after surgery. RESULTS: There was significantly higher leakage of high sensitivity troponin T (peak change median 2 ng/L, IQR 0.9-6.2 ng/L vs 0.6 ng/L, IQR 0.7-2.1 ng/L, p = .0002) and pro b-type natriuretic peptide (change median 144 pg/mL, IQR 17-318 pg/mL vs 51 pg/mL, IQR 12-196 pg/mL, p = .02) in the sham group compared to the RIPC group. CONCLUSION: RIPC reduces the leakage of high sensitivity troponin T and pro b-type natriuretic peptide. Therefore, it may offer cardioprotection in patients undergoing non-cardiac vascular surgery. The clinical significance of RIPC has to be evaluated in larger studies excluding the factors known to influence its effect.
Authors: Teele Kasepalu; Karl Kuusik; Urmas Lepner; Joel Starkopf; Mihkel Zilmer; Jaan Eha; Mare Vähi; Jaak Kals Journal: Nutr Metab (Lond) Date: 2020-09-18 Impact factor: 4.169
Authors: Karl Kuusik; Teele Kasepalu; Mihkel Zilmer; Jaan Eha; Mare Vähi; Liisi Anette Torop; Jüri Lieberg; Jaak Kals Journal: Oxid Med Cell Longev Date: 2021-12-08 Impact factor: 6.543
Authors: Teele Kasepalu; Karl Kuusik; Urmas Lepner; Joel Starkopf; Mihkel Zilmer; Jaan Eha; Mare Vähi; Jaak Kals Journal: Oxid Med Cell Longev Date: 2020-01-23 Impact factor: 6.543