Hasleton, JM; (2014) Cardiac MRI To Assess The Cardioprotective Efficacy Of Remote Ischaemic Perconditioning In Patients With ST-Elevation Myocardial Infarction. Doctoral thesis , UCL (University College London).

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Abstract

The optimal treatment for acute myocardial infarction (AMI) requires the rapid restoration of flow in the infarct related artery and reperfusion of the myocardium at the tissue level through angioplasty. Coronary angioplasty, in the setting of AMI, is aimed at reducing myocardial infarct size, preserving left ventricular function and improving long term outcomes. Paradoxically, the opening of an occluded vessel following a period of ischaemia can result in further myocyte death. This is called lethal reperfusion injury. Current treatments for AMI have failed to attenuate reperfusion injury and combined morbidity and mortality rates remain high. There is an urgent need for the development of novel cardioprotective therapies in the clinical arena. Remote ischaemic perconditioning describes the cardioprotective effect evoked by applying brief episodes of ischaemia and reperfusion applied to a limb with a blood pressure cuff prior to reperfusion but following the onset of ischaemia. Such strategies have been utilised in a number of proof of concept studies demonstrating the ability of remote ischaemic conditioning to attenuate reperfusion injury and reduce infarct size. As therapies for AMI improve, it has become increasingly difficult to demonstrate incremental improvements in currently used biomarkers. Cardiovascular magnetic resonance (CMR) imaging is an important imaging technique that is able to assess traditional imaging parameters with a high degree of accuracy and reproducibility. CMR is also provides supplementary information due to its unique ability to characterise the myocardium and identify the components of reperfusion injury. The identification and quantification of these adverse elements of reperfusion offer further prognostic information beyond traditional imaging biomarkers and show promise as novel endpoints in clinical cardiovascular research. Data is presented on the use of remote ischaemic perconditioning in patients undergoing primary angioplasty. CMR endpoints have been utilised to assess the efficacy of this conditioning protocol in a high-risk patient group.

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