Effect of remote ischemic preconditioning on preoperative heart rate variability in patients undergoing heart valve surgery: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Zhipeng ^1,2,3 , ZHANG Jian ² , SHI Fengyan ^1,2 , LI Rui ² , XIN Fangran ² , YIN Zongtao ² ,  HAN Jinsong ^1,2

1. Graduate School, General Hospital of Northern Theater Command, China Medical University, Shenyang, 110016, P. R. China;
2. Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;
3. Xiongan Xuanwu Hospital, Xiongan New Area, 071702, P. R. China;

Corresponding author：

HAN Jinsong, Email: hanjs0216@sina.com

Keywords：

Remote ischemic preconditioning; cardiac valve surgery; heart rate variability

DOI：

10.7507/1007-4848.202401072

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Objective Explore the effect of remote ischemic preconditioning (RIPC) on preoperative heart rate variability in patients with heart valves. Methods From January 2022 to July 2022, screening was conducted among 118 patients based on inclusion/exclusion criteria. Fifty-eight patients were excluded, and 60 patients participated in this trial with informed consent and were randomly divided into a RIPC group (n=30) and a control group (n=30). Due to the cancellation of surgery, HRV data was missing. 7 patients in the control group were excluded, and 5 patients in the RIPC group were excluded, 23 patients in the final control group and 25 patients in the RIPC group were included in the analysis. Comparison of relevant indicators of heart rate variability (standard deviation of NN interval (SDNN), standard deviation of mean value of NN interval in every five minutes (SDANN), mean square root of difference between consecutive NN intervals (RMSSD), percentage of adjacent RR interval>50 ms (PNN50), low frequency component (LF), high frequency component (HF) and LF/HF) at 8 hours in the morning on the surgical day between two groups of patients. Results There was no statistical difference in baseline characteristics between the two groups, and there was no significant difference in heart rate variability 24 hours before intervention (P>0.05). After the intervention measures were taken, the comparison of the results of heart rate variability at 8 hours on the day of operation showed that SDNN and SDANN of patients in the RIPC group were higher than those in the control group, with statistical differences (P<0.05). Conclusion RIPC can stabilize the preoperative heart rate variability of patients undergoing cardiac valve surgery.

1.	Przyklenk K, Bauer B, Ovize M, et al. Regional ischemic 'preconditioning' protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation, 1993, 87(3): 893-899.
2.	Guo ZN, Guo WT, Liu J, et al. Changes in cerebral autoregulation and blood biomarkers after remote ischemic preconditioning. Neurology, 2019, 93(1): e8-e19.
3.	Papadopoulou A, Dickinson M, Samuels TL, et al. Remote ischaemic preconditioning in intra-abdominal cancer surgery (RIPCa): A pilot randomised controlled trial. J Clin Med, 2022, 11(7): 1770.
4.	Choi E K, Jung H, Jeon S, et al. Role of remote ischemic preconditioning in hepatic ischemic reperfusion injury. dose-response : A publication of International Hormesis Society, 2020, 18(3): 1559325820946923.
5.	Chen H S, Cui Y, Li X Q, et al. Effect of remote ischemic conditioning vs usual care on neurologic function in patients with acute moderate ischemic stroke: The RICAMIS randomized clinical trial. JAMA, 2022, 328(7): 627-636.
6.	Cygankiewicz I, Zareba W. Heart rate variability. Handb Clin Neurol, 2013, 117(379-93.
7.	Gullett N, Zajkowska Z, Walsh A, et al. Heart rate variability (HRV) as a way to understand associations between the autonomic nervous system (ANS) and affective states: A critical review of the literature. Intern J Psychophysiol, 2023, 192: 35-42.
8.	Arakaki X, Arechavala RJ, Choy EH, et al. The connection between heart rate variability (HRV), neurological health, and cognition: A literature review. Front Neurosc, 2023, 17: 1055445.
9.	Khaliulin I, Fleishman AN, Shumeiko NI, et al. Neuro-autonomic changes induced by remote ischemic preconditioning (RIPC) in healthy young adults: Implications for stress. Neurobiol Stress, 2019, 11: 100189.
10.	Abdul-Ghani S, Fleishman AN, Khaliulin I, et al. Remote ischemic preconditioning triggers changes in autonomic nervous system activity: Implications for cardioprotection. Physiol Rep, 2017, 5(3): e13085.
11.	Gardner RN, Sabino-Carvalho JL, Kim J, et al. Two weeks of remote ischaemic preconditioning alters sympathovagal balance in healthy humans. Exp Physiol, 2020, 105(9): 1500-1506.
12.	Oxman T, Arad M, Klein R, et al. Limb ischemia preconditions the heart against reperfusion tachyarrhythmia. The Am J Physiol, 1997, 273(4): H1707-H1712.
13.	Bankwala Z, Hale SL, Kloner RA. Alpha-adrenoceptor stimulation with exogenous norepinephrine or release of endogenous catecholamines mimics ischemic preconditioning. Circulation, 1994, 90(2): 1023-1028.
14.	Zafeiropoulos S, Doundoulakis I, Farmakis IT, et al. Autonomic Neuromodulation for atrial fibrillation following cardiac surgery: JACC review topic of the week. J Am Coll Cardiol, 2022, 79(7): 682-94.
15.	王洋, 尹宗涛, 姜辉, 等. 术前心率变异性预测非体外循环下冠状动脉旁路移植术后新发心房颤动的回顾性研究. 中国胸心血管外科临床杂志, 2023, 30(1): 121-125.
16.	Chamchad D, Djaiani G, Jung HJ, et al. Nonlinear heart rate variability analysis may predict atrial fibrillation after coronary artery bypass grafting. Anesth Analg, 2006, 103(5): 1109-1112.

1. Przyklenk K, Bauer B, Ovize M, et al. Regional ischemic 'preconditioning' protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation, 1993, 87(3): 893-899.
2. Guo ZN, Guo WT, Liu J, et al. Changes in cerebral autoregulation and blood biomarkers after remote ischemic preconditioning. Neurology, 2019, 93(1): e8-e19.
3. Papadopoulou A, Dickinson M, Samuels TL, et al. Remote ischaemic preconditioning in intra-abdominal cancer surgery (RIPCa): A pilot randomised controlled trial. J Clin Med, 2022, 11(7): 1770.
4. Choi E K, Jung H, Jeon S, et al. Role of remote ischemic preconditioning in hepatic ischemic reperfusion injury. dose-response : A publication of International Hormesis Society, 2020, 18(3): 1559325820946923.
5. Chen H S, Cui Y, Li X Q, et al. Effect of remote ischemic conditioning vs usual care on neurologic function in patients with acute moderate ischemic stroke: The RICAMIS randomized clinical trial. JAMA, 2022, 328(7): 627-636.
6. Cygankiewicz I, Zareba W. Heart rate variability. Handb Clin Neurol, 2013, 117(379-93.
7. Gullett N, Zajkowska Z, Walsh A, et al. Heart rate variability (HRV) as a way to understand associations between the autonomic nervous system (ANS) and affective states: A critical review of the literature. Intern J Psychophysiol, 2023, 192: 35-42.
8. Arakaki X, Arechavala RJ, Choy EH, et al. The connection between heart rate variability (HRV), neurological health, and cognition: A literature review. Front Neurosc, 2023, 17: 1055445.
9. Khaliulin I, Fleishman AN, Shumeiko NI, et al. Neuro-autonomic changes induced by remote ischemic preconditioning (RIPC) in healthy young adults: Implications for stress. Neurobiol Stress, 2019, 11: 100189.
10. Abdul-Ghani S, Fleishman AN, Khaliulin I, et al. Remote ischemic preconditioning triggers changes in autonomic nervous system activity: Implications for cardioprotection. Physiol Rep, 2017, 5(3): e13085.
11. Gardner RN, Sabino-Carvalho JL, Kim J, et al. Two weeks of remote ischaemic preconditioning alters sympathovagal balance in healthy humans. Exp Physiol, 2020, 105(9): 1500-1506.
12. Oxman T, Arad M, Klein R, et al. Limb ischemia preconditions the heart against reperfusion tachyarrhythmia. The Am J Physiol, 1997, 273(4): H1707-H1712.
13. Bankwala Z, Hale SL, Kloner RA. Alpha-adrenoceptor stimulation with exogenous norepinephrine or release of endogenous catecholamines mimics ischemic preconditioning. Circulation, 1994, 90(2): 1023-1028.
14. Zafeiropoulos S, Doundoulakis I, Farmakis IT, et al. Autonomic Neuromodulation for atrial fibrillation following cardiac surgery: JACC review topic of the week. J Am Coll Cardiol, 2022, 79(7): 682-94.
15. 王洋, 尹宗涛, 姜辉, 等. 术前心率变异性预测非体外循环下冠状动脉旁路移植术后新发心房颤动的回顾性研究. 中国胸心血管外科临床杂志, 2023, 30(1): 121-125.
16. Chamchad D, Djaiani G, Jung HJ, et al. Nonlinear heart rate variability analysis may predict atrial fibrillation after coronary artery bypass grafting. Anesth Analg, 2006, 103(5): 1109-1112.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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