title: Is Local Nitric Oxide Availability Responsible for Myocardial Salvage after Remote Preconditioning?
abstract: BACKGROUND
  Remote ischemic preconditioning (RIPC) represents an attractive therapy for myocardial protection, particularly when ischemic events can be anticipated. Although several hypothetic mechanisms have been proposed, no definite molecular pathways have been elucidated.
  
  
  OBJECTIVE
  We evaluated the effect of brachial circulation cuff occlusion on myocardial ischemic tolerance, necrosis, and nitric oxide (NO) in patients with ischemic heart disease undergoing elective percutaneous coronary interventions (PCI).
  
  
  METHODS
  46 patients were randomly allocated into two groups: control and RIPC before PCI procedures. Electrocardiographic analysis, serum concentrations of troponin I (cTn-I) were measured at baseline and 24 hours after PCI. A blood sample from the atherosclerotic plaque was drawn to determine nitrate and nitrites.
  
  
  RESULTS
  RIPC increased the availability of NO in the stented coronary artery. Control patients presented a small but significant increase in cTn-I, whilst it remained unchanged in preconditioned group. The preconditioning maneuver not only preserved but also enhanced the sum of R waves.
  
  
  CONCLUSIONS
  RIPC induced an intracoronary increase of NO levels associated with a decrease in myocardial damage (measured as no increase in cTn-I) with electrocardiographic increases in the sum of R waves, suggesting an improved myocardium after elective PCI.
authors.affiliation: Unidade Cardiovascular, Hospital "Primero de Octubre", Cidade do México, México.
authors.forename: Esbeidira Aranet
authors.initials: EA
authors.lastname: Arroyo-Martínez
authors.affiliation: Unidade Cardiovascular, Hospital "Primero de Octubre", Cidade do México, México.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Meaney
authors.affiliation: Faculdade de Ciências da Saúde, Universidade Anáhuac México Norte, Cidade do México, Mexico.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Gutiérrez-Salmeán
authors.affiliation: Unidade Cardiovascular, Hospital "Primero de Octubre", Cidade do México, México.
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Rivera-Capello
authors.affiliation: Unidade Cardiovascular, Hospital "Primero de Octubre", Cidade do México, México.
authors.forename: Vidal
authors.initials: V
authors.lastname: González-Coronado
authors.affiliation: Unidade Cardiovascular, Hospital "Primero de Octubre", Cidade do México, México.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Alcocer-Chauvet
authors.affiliation: Unidade Cardiovascular, Hospital "Primero de Octubre", Cidade do México, México.
authors.forename: Genaro
authors.initials: G
authors.lastname: Castillo
authors.affiliation: Laboratório de Investigação Integral Cardiometabólica, Escola Superior de Medicina, Instituto Politécnico Nacional, Cidade do México, Mexico.
authors.forename: Nayelli
authors.initials: N
authors.lastname: Nájera
authors.affiliation: Laboratório de Investigação Integral Cardiometabólica, Escola Superior de Medicina, Instituto Politécnico Nacional, Cidade do México, Mexico.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ceballos
authors.affiliation: Laboratório de Investigação Integral Cardiometabólica, Escola Superior de Medicina, Instituto Politécnico Nacional, Cidade do México, Mexico.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Meaney
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D009569:Nitric Oxide / Q000097:blood / Q000378:metabolism*; D052250:Nitric Oxide Synthase Type III / Q000378:metabolism; D062645:Percutaneous Coronary Intervention; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I; D009569:Nitric Oxide; D003404:Creatinine; D052250:Nitric Oxide Synthase Type III