WANG Ling, ZHUANG Zhichuan, WU Yinyin, YANG Jintao, LIU Lili. Effect of remote ischemic preconditioning combined with transcutaneous vagus nerve stimulation on reperfusion injury in ST-segment elevation myocardial infarction[J]. Journal of Clinical Medicine in Practice, 2023, 27(23): 54-59. DOI: 10.7619/jcmp.20232168
Citation: WANG Ling, ZHUANG Zhichuan, WU Yinyin, YANG Jintao, LIU Lili. Effect of remote ischemic preconditioning combined with transcutaneous vagus nerve stimulation on reperfusion injury in ST-segment elevation myocardial infarction[J]. Journal of Clinical Medicine in Practice, 2023, 27(23): 54-59. DOI: 10.7619/jcmp.20232168

Effect of remote ischemic preconditioning combined with transcutaneous vagus nerve stimulation on reperfusion injury in ST-segment elevation myocardial infarction

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  • Received Date: July 06, 2023
  • Revised Date: October 30, 2023
  • Available Online: December 25, 2023
  • Objective 

    To investigate effect of remote ischemic preconditioning (RIPC)combined with transcutaneous vagus nerve stimulation (tVNS) on reperfusion injury in ST-segment elevation myocardial infarction (STEMI).

    Methods 

    A total of 132 STEMI patients were selected, and were randomly divided into control group, tVNS group and combined group (RIPC combined with tVNS) before percutaneous coronary intervention (PCI). A total of 9 of the 132 patients were excluded, including 42 in the control group, 40 in the tVNS group, and 41 in the combination group. The area under the curve (AUC) of creatine kinase isoenzyme (CK-MB) within 72 h and the ventricular arrhythmia (VAs) within 24 h after reperfusion were compared among the three groups. The levels of interleukin-6 (IL-6), high mobility group protein B1(HMGB1), tumor necrosis factor-α (TNF-α) and left ventricular ejection fraction (LVEF) of the three groups were compared at admission and 24 h after reperfusion.

    Results 

    The AUC of CK-MB in the combination group was significantly lower than that in the control group within 72 h (P < 0.05). The total number of premature ventricular beats and the number of ventricular tachycardia in the tVNS group and combined group were significantly lower than those in the control group within 24 h after reperfusion (P < 0.05). The levels of IL-6, HMGB1 and TNF-α in the combination group were significantly lower than those in the control group 24 h after reperfusion (P < 0.05). LVEF in the combination group was significantly higher than that in the light group at 7 days after reperfusion (P < 0.05).

    Conclusion 

    The tVNS significantly reducs the incidence of VAs after PCI in STEMI patients, but has little effect on the level of reperfusion inflammatory markers, myocardial infarction size, and acute left ventricular systolic function. The tVNS combined with RICP can produce significant benefits in the above indexes.

  • [1]
    ARSLAN F, BONGARTZ L, TEN BERG J M, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: comments from the Dutch ACS working group[J]. Neth Heart J, 2018, 26(9): 417-421.
    [2]
    ILIODROMITIS E K, COHEN M V, DOWNEY J M. Remote Ischemic Conditioning: more explanations and more expectations[J]. Basic Res Cardiol, 2022, 117(1): 49. doi: 10.1007/s00395-022-00959-y
    [3]
    HAUSENLOY D J, KHARBANDA R K, MØLLER U K, et al. Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial[J]. Lancet, 2019, 394(10207): 1415-1424. doi: 10.1016/S0140-6736(19)32039-2
    [4]
    PEUKER E T, FILLER T J. The nerve supply of the human auricle[J]. Clin Anat, 2002, 15(1): 35-37. doi: 10.1002/ca.1089
    [5]
    CARRENO F R, FRAZER A. The allure of transcutaneous vagus nerve stimulation as a novel therapeutic modality[J]. Biol Psychiatry, 2016, 79(4): 260-261. doi: 10.1016/j.biopsych.2015.11.016
    [6]
    顾楠楠, 李春波. 经皮迷走神经刺激术研究进展[J]. 上海交通大学学报: 医学版, 2020, 40(4): 539-542. https://www.cnki.com.cn/Article/CJFDTOTAL-TJIY202206016.htm
    [7]
    CHEN M X, LI X P, YANG H, et al. Hype or hope: Vagus nerve stimulation against acute myocardial ischemia-reperfusion injury[J]. Trends Cardiovasc Med, 2020, 30(8): 481-488. doi: 10.1016/j.tcm.2019.10.011
    [8]
    中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J]. 中华心血管病杂志, 2019, 47(10): 766-783. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXB201709002.htm
    [9]
    PRZYKLENK K, BAUER B, OVIZE M, et al. Regional ischemic 'preconditioning' protects remote virgin myocardium from subsequent sustained coronary occlusion[J]. Circulation, 1993, 87(3): 893-899. doi: 10.1161/01.CIR.87.3.893
    [10]
    FRANCIS R, CHONG J, RAMLALL M, et al. Effect of remote ischaemic conditioning on infarct size and remodelling in ST-segment elevation myocardial infarction patients: the CONDI-2/ERIC-PPCI CMR substudy[J]. Basic Res Cardiol, 2021, 116(1): 1-12. doi: 10.1007/s00395-020-00840-w
    [11]
    CHEN E, CAI W, HU D, et al. Effect of remote ischemic preconditioning in patients with STEMI during primary percutaneous coronary intervention: a meta-analysis of randomized controlled trials[J]. Rev Cardiovasc Med, 2020, 21(1): 103. doi: 10.31083/j.rcm.2020.01.10
    [12]
    CHEN S M, LI S J, FENG X H, et al. Cardioprotection of repeated remote ischemic conditioning in patients with ST-segment elevation myocardial infarction[J]. Front Cardiovasc Med, 2022, 9: 899302. doi: 10.3389/fcvm.2022.899302
    [13]
    CHEN M X, ZHOU X Y, YU L L, et al. Low-level vagus nerve stimulation attenuates myocardial ischemic reperfusion injury by antioxidative stress and antiapoptosis reactions in canines[J]. J Cardiovasc Electrophysiol, 2016, 27(2): 224-231. doi: 10.1111/jce.12850
    [14]
    ZHANG L, LU Y M, SUN J, et al. Subthreshold vagal stimulation suppresses ventricular arrhythmia and inflammatory response in a canine model of acute cardiac ischaemia and reperfusion[J]. Exp Physiol, 2016, 101(1): 41-49. doi: 10.1113/EP085518
    [15]
    YU L L, HUANG B, PO S S, et al. Low-level Tragus stimulation for the treatment of ischemia and reperfusion injury in patients with ST-segment elevation myocardial infarction: a proof-of-concept study[J]. JACC Cardiovasc Interv, 2017, 10(15): 1511-1520. doi: 10.1016/j.jcin.2017.04.036
    [16]
    WANG S Y, ZHOU X Y, HUANG B, et al. Noninvasive low-frequency electromagnetic stimulation of the left stellate ganglion reduces myocardial infarction-induced ventricular arrhythmia[J]. Sci Rep, 2016, 6: 30783. doi: 10.1038/srep30783
    [17]
    CHEN M X, CHEN H, WANG Z, et al. Non-invasive tragus stimulation improves cardiac post-ischemic remodeling by regulating cardiac parasympathetic activity[J]. ESC Heart Fail, 2022, 9(6): 4129-4138. doi: 10.1002/ehf2.14146
    [18]
    YU L L, WANG S Y, ZHOU X Y, et al. Chronic intermittent low-level stimulation of Tragus reduces cardiac autonomic remodeling and ventricular arrhythmia inducibility in a post-infarction canine model[J]. JACC, 2016, 2(3): 330-339.
    [19]
    祝海霞, 杨志, 薛文婧, 等. 经皮迷走神经刺激治疗老年难治性高血压的临床研究[J]. 老年医学与保健, 2022, 28(3): 554-558. https://www.cnki.com.cn/Article/CJFDTOTAL-LYBJ202203021.htm
    [20]
    LASSEN T R, JUST J, HJORTBAK M V, et al. Cardioprotection by remote ischemic conditioning is transferable by plasma and mediated by extracellular vesicles[J]. Basic Res Cardiol, 2021, 116(1): 16. doi: 10.1007/s00395-021-00856-w
    [21]
    CAO B M, WANG H P, ZHANG C, et al. Remote ischemic postconditioning (RIPC) of the upper arm results in protection from cardiac ischemia-reperfusion injury following primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI)[J]. Med Sci Monit, 2018, 24: 1017-1026. doi: 10.12659/MSM.908247
    [22]
    肖四海, 宋巧凤, 王晓玲, 等. 心肌梗死患者心肌酶谱、急性生理和慢性健康评分与预后的相关性分析[J]. 中国临床医生杂志, 2019, 47(12): 1438-1440. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS201912019.htm
    [23]
    郭晋, 王方莉, 伍德生. cTnI、BNP及心肌酶谱联合检测在急性冠脉综合症诊治中的临床意义[J]. 中华全科医学, 2013, 11(9): 1370-1372. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201309023.htm
    [24]
    GONG R, WU Y Q. Remote ischemic conditioning during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis[J]. J Cardiothorac Surg, 2019, 14: 14. doi: 10.1186/s13019-019-0834-x
    [25]
    黎真真, 陈飞任, 吴红发, 等. 异丙酚对心肌缺血再灌注损伤大鼠模型Toll样受体4及高迁移率族蛋白1表达的影响[J]. 实用临床医药杂志, 2021, 25(3): 13-18. doi: 10.7619/jcmp.20201602
    [26]
    鲁涛, 曹梦舒, 郑云, 等. 游泳运动预处理抑制钙蛋白酶活性减轻心肌细胞膜的缺血-再灌注损伤[J]. 空军军医大学学报, 2022, 43(2): 48-52, 59. https://www.cnki.com.cn/Article/CJFDTOTAL-DSJY202202009.htm
    [27]
    张丹, 操传斌, 姚维, 等. 低强度经耳迷走神经刺激在非ST段抬高型心肌梗死患者早期PCI术中的应用[J]. 湖北医药学院学报, 2019, 38(3): 264-268. https://www.cnki.com.cn/Article/CJFDTOTAL-YYYX201903013.htm

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