title: [PROTEIN KINASE C EXPRESSION FOLLOWING REMOTE ISCHEMIC PRECONDITIONING IN CARDIAC SURGERY].
abstract: OBJECTIVE
  To evaluate cardioprotective effects of remote ischemic preconditioning (RIPC) in cardiac surgery patients undergoing aortic valve replacement depending on the type of anesthesia and investigate the level of myocardial protein kinase C epsilon (PKC-ε) expression after RIPC.
  
  
  METHODS
  In prospective randomized trial, forty eight patients aging from 50 to 75 years old (64 (56 ;69)) were included All patients were scheduled for aortic valve replacement using cardiopulmonary bypass (CPB). The patients were randomized into 4 groups: 1) RIPC applied during propofol anesthesia (RIPC prop, n = 12), 2) RIPC applied during sevoflurane anesthesia (RIPC sev, n = 12), 3) propofol anesthesia without RIPC (CONTROL prop, n = 12), 4) sevoflurane anesthesia without RIPC (CONTROL sev, n = 12). There was no difference found between the groups as to the baseline patient's data. RIPC protocol consisted of 3 simultaneous ischemic episodes of both lower limbs (5 minutes) with 5-min reperfusion intervals. PKC-ε expression in right atrial myocardium was assessed using Western blotting. Troponin I (cTnI) was estimated before anesthesia induction, after 30 min, 6, 12, 24, 48 hours after CPB completion. Also we calculated area under curve of cTnI (cTnI AUC). According to nonparametric distribution, data were assessed by the Mann-Whitney U-test and Newman-Keuls methodfor multigroup comparison. p < 0.05 was considered signifcant. The data are presented as median (25th; 75th percentile).
  
  
  RESULTS
  Cardioprotective effects of RIPC were observed only after sevoflurane anesthesia: cTnI AUC was 134,8 (122,3; 232.4) ng/ml/48 h in CONTROL sev group and only 74.3 (64.7; 85.0) ng/ml/48 h in RIPC sev group (p < 0.05). RIPC applied during propofol anesthesia was not associated with cTnIAUC decrease: 93.8 (74.1; 246.8) ng/ml/48 h in CONTROL prop group and 122.5 (74.1; 185.0) ng/ml/48 h in RIPC prop group (p = 0.37). RIPC applied during sevoflurane anesthesia significantly increased PKC-ε expression: 1221 (921; 1438) U in CONTROL sev group vs 1882 (1564; 2131) U in RIPC sev group 6 (p < 0.05). RIPC implication during propofol anesthesia was not associated with any significant difference in PKC-ε expression in comparison with control group: 620 (436; 782) U in CONTROL prop group versus 788 (574;1063) U in RIPC prop group. In control groups, PKC-ε expression was significantly higher in sevoflurane anesthesia in comparison with propofol anesthesia.
  
  
  CONCLUSIONS
  RIPC was only effective when it was applied during sevofiurane anesthesia. This was confirmed by PKC-ε expression increase and lower value of cTnI. There were no evidence of preconditioning and cardioprotection when MPG was initiated during propofol anesthesia.
authors.forename: A E
authors.initials: AE
authors.lastname: Bautin
authors.forename: M M
authors.initials: MM
authors.lastname: Galagudza
authors.forename: D M
authors.initials: DM
authors.lastname: Tashkhanov
authors.forename: S V
authors.initials: SV
authors.lastname: Datsenko
authors.forename: A O
authors.initials: AO
authors.lastname: Marichev
authors.forename: A A
authors.initials: AA
authors.lastname: Kostareva
authors.forename: E N
authors.initials: EN
authors.lastname: Kravchuk
authors.forename: A Yu
authors.initials: AY
authors.lastname: Bakanov
authors.forename: M L
authors.initials: ML
authors.lastname: Gordeev
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D001021:Aortic Valve / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015151:Immunoblotting; D019194:Ischemic Preconditioning / Q000379:methods*; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D032383:Myocytes, Cardiac / Q000201:enzymology; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D051744:Protein Kinase C-epsilon / Q000096:biosynthesis* / Q000378:metabolism; D000077149:Sevoflurane; D019210:Troponin I / Q000097:blood
chemical_list: D008738:Methyl Ethers; D019210:Troponin I; D000077149:Sevoflurane; D051744:Protein Kinase C-epsilon; D015742:Propofol