title: Upper arm intermittent ischaemia reduces exercise-related increase of platelet reactivity in patients with obstructive coronary artery disease.
abstract: OBJECTIVE
  To assess whether upper arm ischaemia influences exercise-induced myocardial ischaemia and platelet activation in patients with coronary artery disease (CAD).
  
  
  METHODS
  Crossover study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twenty patients (17 men) of mean±SD age 64±8 years with stable CAD.
  
  
  METHODS
  Patients underwent two exercise stress tests (ESTs) on two separate days in a randomised manner: (1) a maximal EST only (EST-1); (2) a maximal EST after intermittent upper arm ischaemia (cycles of alternating 5-min inflation and 5-min deflation of a standard blood pressure cuff) (EST-2). Blood samples were obtained to evaluate platelet reactivity.
  
  
  METHODS
  Platelet reactivity was assessed by flow cytometry at rest and after EST, with and without ADP stimulation, by measuring the percentage of monocyte-platelet aggregates (MPAs) and CD41 platelet expression measured as mean fluorescence intensity.
  
  
  RESULTS
  Remote ischaemia had no significant effect on EST-induced myocardial ischaemia. At rest there were no differences before EST-1 and EST-2 in basal MPA (20.7±2.3 vs 20.8±2.4, p=0.56) and CD41 (21.5±2.3 vs 21.3±2.3, p=0.39), and ADP stimulation induced a similar increase in both MPA (+15.2±8.2% vs +14.9±8.4%, p=0.71) and CD41 (+15.7±5.7% vs 13.37±6.9%, p=0.59). While no differences in the increase in MPA and CD41 expression were observed after EST-1 and EST-2, ADP stimulation after EST-2 induced a lower increase in MPA (+18.3±8.1% vs +27.9±9.7%, p<0.001) and CD41 (+18.3±9.2% vs +27.2±12.4%, p<0.001) than after EST-1.
  
  
  CONCLUSIONS
  These results show that, in patients with stable CAD, remote ischaemia induces protection against an exercise-related increase in platelet reactivity.
authors.affiliation: Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Irma
authors.initials: I
authors.lastname: Battipaglia
authors.forename: Giancarla
authors.initials: G
authors.lastname: Scalone
authors.forename: Maria
authors.initials: M
authors.lastname: Milo
authors.forename: Antonino
authors.initials: A
authors.lastname: Di Franco
authors.forename: Gaetano A
authors.initials: GA
authors.lastname: Lanza
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply*; D023921:Coronary Stenosis / Q000097:blood; D018592:Cross-Over Studies; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000517:prevention & control*; D015539:Platelet Activation / Q000502:physiology*; D010974:Platelet Aggregation / Q000502:physiology