Effects of remote ischaemic preconditioning on arterial stiffness, organ damage and metabolomic profile in patients with lower extremity artery disease
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2024-06-06
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Abstract
Kaugisheemiline eelkohastamine (KIE) on protseduur, mille eesmärgiks on kaitsta kudesid ja elundeid verevarustuse häiretest tingitud kahjustuste eest. Lisaks erakorralistele situatsioonidele esineb sellist kahjustust igapäevase plaanilise meditsiinilise tegevuse käigus, kus vajaliku raviga kaasnevate tüsistuste oht on kõrgem juba suure haiguskoormuse ja riskidega patsientidel. Selliste haigete rühma kuuluvad ka alajäsemete arterite haigusega (AAH) patsiendid. KIE protseduur hõlmab korduvaid lühiajalisi verevarustuse katkestamise ja taastamise tsükleid eemalasetsevas koes, eelistatult ülajäsemes, tekitades rakkudes ja kudedes soodsaid kohastumuslikke muutuseid eesmärgiga kaitsta verevarustushäiretest tingitud kahjustuste eest.
Käesolev doktoritöö uuris KIE mõju AAH patsientidel digitaalse subtraktsioon angiograafia ja endovaskulaarse raviprotseduuri järgselt, keskendudes muutustele arterite jäikuses, neeru- ja südamekahjustuste näitajates, põletikus, oksüdatiivses stressis ja metaboolses profiililis. Uuringusse kaasati 111 AAH patsienti, kes jaotati juhuslikustamise alusel KIE-rühma ja kontrollrühma vahel. KIE-rühma patsientidele tekitati neljal korral järjest õlavarrele asetatud vererõhumansetiga lühiajalised verevarustuse peatamise episoodid, millele järgnes verevarustuse taastamise periood. Kontrollgrupis teostati sarnasel kombel vererõhumanseti täitmist minimaalsete rõhkude juures.
Tulemused näitasid, et KIE-rühmas paranesid võrreldes kontrollrühmaga märkimisväärselt arterite jäikuse näitajad ja esines keskmise arteriaalse vererõhu langus. Muutused olid enam väljendunud patsientidel, kellele paigaldati endovaskulaarse ravi käigus stent. Samas ei ilmnenud neeru- ja südamekahjustuses märkimisväärseid muutuseid. KIE protseduuril oli oluline mõju põletikulise aktiivsuse ja oksüdatiivse stressi näitajatele piirates teatud tervisenäitajate, nagu adiponektiini, taseme tõusu pärast protseduuri. Lisaks viitavad muutused metaboolses profiilis KIE võimele vähendada verevarustuse häiretest ja nende järgsest taastumisest tingitud muutuseid.
KIE on ohutu ja kergesti rakendatav meetod, mis vähendab diagnostiliste ja raviprotseduuridega seotud riske AAH patsientidel, muutes ravi personaalsemaks ja seeläbi ka efektiivsemaks.
Remote ischaemic preconditioning (RIPC) is a phenomenon aimed at protecting the body's tissues and organs from damage caused by disruptions in blood supply. In addition to emergency situations, such damage also occurs in the course of everyday planned medical activities, where the risk of complications associated with necessary treatment is higher in patients already burdened with significant disease and risks. One group of such patients includes those suffering from lower extremity arterial disease (LEAD). The RIPC procedure involves repeated short-term cycles of halting blood supply followed by its restoration, typically applied to the upper limb. This action generates a protective effect in organs or tissues sensitive to blood supply disruptions that are situated farther away. This doctoral thesis investigated the effects of RIPC on LEAD patients following digital subtraction angiography and endovascular interventions, focusing on changes in arterial stiffness, indicators of kidney and heart damage, inflammation, oxidative stress and metabolic profile. The study included 111 LEAD patients who were randomly divided between a RIPC group and a control group. Patients in the RIPC group underwent four consecutive episodes of short-term blood supply cessation on the upper arm using a blood pressure cuff, followed by a period of blood supply restoration. In control arm blood cuff was filled only partially. The results showed that in the RIPC group, there was a significant improvement in arterial stiffness indicators and a reduction in mean arterial pressure. Changes were more pronounced after stent placement following endovascular intervention. However, there were no significant changes in markers of kidney and heart damage. The RIPC procedure had a significant impact on the inflammatory response and oxidative stress response, limiting the increase in certain health indicators, such as adiponectin levels, following the procedure. Furthermore, changes in the metabolomic profile of the RIPC group suggest the potential of RIPC to reduce damage caused by blood supply disruptions and their subsequent recovery. In conclusion, RIPC is a safe and easily applicable method that reduces the risks associated with diagnostic and therapeutic procedures in LEAD patients, making treatment personalized and therefore also more effective.
Remote ischaemic preconditioning (RIPC) is a phenomenon aimed at protecting the body's tissues and organs from damage caused by disruptions in blood supply. In addition to emergency situations, such damage also occurs in the course of everyday planned medical activities, where the risk of complications associated with necessary treatment is higher in patients already burdened with significant disease and risks. One group of such patients includes those suffering from lower extremity arterial disease (LEAD). The RIPC procedure involves repeated short-term cycles of halting blood supply followed by its restoration, typically applied to the upper limb. This action generates a protective effect in organs or tissues sensitive to blood supply disruptions that are situated farther away. This doctoral thesis investigated the effects of RIPC on LEAD patients following digital subtraction angiography and endovascular interventions, focusing on changes in arterial stiffness, indicators of kidney and heart damage, inflammation, oxidative stress and metabolic profile. The study included 111 LEAD patients who were randomly divided between a RIPC group and a control group. Patients in the RIPC group underwent four consecutive episodes of short-term blood supply cessation on the upper arm using a blood pressure cuff, followed by a period of blood supply restoration. In control arm blood cuff was filled only partially. The results showed that in the RIPC group, there was a significant improvement in arterial stiffness indicators and a reduction in mean arterial pressure. Changes were more pronounced after stent placement following endovascular intervention. However, there were no significant changes in markers of kidney and heart damage. The RIPC procedure had a significant impact on the inflammatory response and oxidative stress response, limiting the increase in certain health indicators, such as adiponectin levels, following the procedure. Furthermore, changes in the metabolomic profile of the RIPC group suggest the potential of RIPC to reduce damage caused by blood supply disruptions and their subsequent recovery. In conclusion, RIPC is a safe and easily applicable method that reduces the risks associated with diagnostic and therapeutic procedures in LEAD patients, making treatment personalized and therefore also more effective.
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