Changes in cerebral autoregulation and blood biomarkers after remote ischemic preconditioning

Z, Guo; Guo, Wei; Liu, Jia; Chang, Junlei; Hanson, Mark A.; Zhang, Peng; Zhang, Fu Liang; Han, Ke; Hu, Han Hwa; Jin, Hang; Sun, Xin; Simpson, David M.; Yang, Yi

doi:10.1212/wnl.0000000000007732

Cited by 50 publications

(55 citation statements)

References 48 publications

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“…Given the evidence rIPC has systemic beneficial effects on vascular regulation and endothelial function (15,17), improvements to blood vessel function may translate to enhanced responsiveness to blood pressure within cerebral vessels (dynamic cerebral autoregulation). Additionally, application of rIPC can regulate several vasoactive biomarkers including, nitric oxide, adenosine and bradykinin (12,23), which may have the potential to enhance dCA (24,25,26).…”

Section: Introductionmentioning

confidence: 99%

Seven-day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus: a randomised pilot study

Maxwell

Carter

Hellsten

et al. 2019

European Journal of Endocrinology

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Background Remote ischaemic preconditioning (rIPC) may improve cardiac/cerebrovascular outcomes of ischaemic events. Ischaemic damage caused by cardiovascular/cerebrovascular disease are primary causes of mortality in type 2 diabetes mellitus (T2DM). Due to the positive effects from a bout of rIPC within the vasculature, we explored if daily rIPC could improve endothelial and cerebrovascular function. The aim of this pilot study was to obtain estimates for the change in conduit artery and cerebrovascular function following a 7-day rIPC intervention. Methods Twenty-one patients with T2DM were randomly allocated to either 7-day daily upper-arm rIPC (4 × 5 min 220 mmHg, interspaced by 5-min reperfusion) or control. We examined peripheral endothelial function using flow mediated dilation (FMD) before and after ischemia-reperfusion injury (IRI, 20 min forearm ischaemic-20 min reperfusion) and cerebrovascular function, assessed by dynamic cerebral autoregulation (dCA) at three time points; pre, post and 8 days post intervention. Results For exploratory purposes, we performed statistical analysis on our primary comparison (pre-to-post) to provide an estimate of the change in the primary and secondary outcome variables. Using pre-intervention data as a covariate, the change from pre-post in FMD was 1.3% (95% CI: 0.69 to 3.80; P = 0.09) and 0.23 %cm/s %/mmHg mmHg/% (−0.12, 0.59; P = 0.18) in dCA normalised gain with rIPC versus control. Based upon this, a sample size of 20 and 50 for FMD and normalised gain, respectively, in each group would provide 90% power to detect statistically significant (P < 0.05) between-group difference in a randomised controlled trial. Conclusion We provide estimates of sample size for a randomised control trial exploring the impact of daily rIPC for 7 days on peripheral endothelial and cerebrovascular function. The directional changes outline from our pilot study suggest peripheral endothelial function can be enhanced by daily rIPC in patients with T2DM.

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Section: Introductionmentioning

confidence: 99%

Seven-day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus: a randomised pilot study

Maxwell

Carter

Hellsten

et al. 2019

European Journal of Endocrinology

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“…Ten acute RIC exposure studies [ 31 , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] ] were considered in this systematic review including one cohort study [ 50 ]. Nine studies (10 comparisons) were eligible for pooling meta-analytically for acute RIC effect.…”

Section: Resultsmentioning

confidence: 99%

The effect of remote ischaemic conditioning on blood pressure response: A systematic review and meta-analysis

Baffour-Awuah

Dieberg

Pearson

et al. 2021

International Journal of Cardiology Hypertension

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Background Previous work has evaluated the effect of remote ischaemic conditioning (RIC) in a number of clinical conditions (e.g. cardiac surgery and acute kidney injury), but only one analysis has examined blood pressure (BP) changes. While individual studies have reported the effects of acute bouts and repeated RIC exposure on resting BP, efficacy is equivocal. We conducted a systematic review and meta-analysis to evaluate the effects of acute and repeat RIC on BP. Methods A systematic search was performed using PubMed, Web of Science, EMBASE, and Cochrane Library of Controlled Trials up until October 31, 2020. Additionally, manual searches of reference lists were performed. Studies that compared BP responses after exposing participants to either an acute bout or repeated cycles of RIC with a minimum one-week intervention period were considered. Results Eighteen studies were included in this systematic review, ten examined acute effects while eight investigated repeat effects of RIC. Mean differences (MD) for outcome measures from acute RIC studies were: systolic BP 0.18 mmHg (95%CI -0.95, 1.31; p = 0.76), diastolic BP -0.43 mmHg (95%CI -2.36, 1.50; p = 0.66), MAP -1.73 mmHg (95%CI -3.11, −0.34; p = 0.01) and HR -1.15 bpm (95%CI -2.92, 0.62; p = 0.20). Only MAP was significantly reduced. Repeat RIC exposure showed non-significant change in systolic BP -3.23 mmHg (95%CI -6.57, 0.11; p = 0.06) and HR -0.16 bpm (95%CI -7.08, 6.77; p = 0.96) while diastolic BP -2.94 mmHg (95%CI -4.08, −1.79; p < 0.00001) and MAP -3.21 mmHg (95%CI -4.82, −1.61; p < 0.0001) were significantly reduced. Conclusions Our data suggests repeated, but not acute, RIC produced clinically meaningful reductions in diastolic BP and MAP.

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“…This finding suggests that regular healthcare was unable to alter CA in patients with minor stroke despite some neurological improvement. Some therapeutic interventions, including antihypertensive medicines and remote ischemic preconditioning, can alter CA [36][37][38] and thus may represent a novel strategy to prevent the onset of PSCI.…”

Section: Characteristics (N = 65)mentioning

confidence: 99%

Impaired cerebral autoregulation is associated with poststroke cognitive impairment

Chi

Chan

et al. 2020

Ann Clin Transl Neurol

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Objective: To investigate whether dynamic cerebral autoregulation (CA) and neuroimaging characteristics are determinants of poststroke cognitive impairment (PSCI). Methods: Eighty patients within 7 days of acute ischemic stroke and 35 age-and sex-matched controls were enrolled. In the patients with stroke, brain magnetic resonance imaging and dynamic CA were obtained at baseline, and dynamic CA was followed up at 3 months and 1 year. Montreal Cognitive Assessment (MoCA) was performed at 3 months and 1 year. Patients with a MoCA score <23 at 1 year were defined as having PSCI, and those with a MoCA score that decreased by 2 points or more between the 3-month and 1year assessments were defined as having progressive cognitive decline. Results: In total, 65 patients completed the study and 16 developed PSCI. The patients with PSCI exhibited poorer results for all cognitive domains than did those without PSCI. The patients with PSCI also had poorer CA (lower phase shift between cerebral blood flow and blood pressure waveforms in the very low frequency band) compared with that of the patients without PSCI and controls at baseline and 1 year. CA was not different between the patients without PSCI and controls. In the multivariate analysis, low education level, lobar microbleeds, and impaired CA (very low frequency phase shift [≤46°] within 7 days of stroke), were independently associated with PSCI. In addition, impaired CA was associated with progressive cognitive decline. Interpretation: Low education level, lobar microbleeds, and impaired CA are involved in the pathogenesis of PSCI.

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Changes in cerebral autoregulation and blood biomarkers after remote ischemic preconditioning

Cited by 50 publications

References 48 publications

Seven-day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus: a randomised pilot study

Seven-day remote ischaemic preconditioning improves endothelial function in patients with type 2 diabetes mellitus: a randomised pilot study

The effect of remote ischaemic conditioning on blood pressure response: A systematic review and meta-analysis

Impaired cerebral autoregulation is associated with poststroke cognitive impairment

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