Mallouppas, Michael;
(2021)
Remote ischaemic conditioning as a cardioprotective mechanism against anthracycline induced cardiac injury and multimodality monitoring of patients receiving anthracycline chemotherapy.
Doctoral thesis (M.D(Res)), UCL (University College London).
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Abstract
Introduction: Remote ischaemic conditioning was investigated as a cardioprotective strategy against anthracycline cardiotoxicity in the clinical setting. Identifying ways to best monitor these was also assessed. Methodology: A randomised double-blind controlled trial of remote ischaemic conditioning vs sham was performed in patients receiving anthracyclines. Conditioning was delivered with 4 cycles of 5-minute inflations/deflations prior to each chemotherapy cycle. High sensitivity troponin T was analysed at baseline, during chemotherapy and at follow-up. Echocardiography was performed at baseline and at follow-up. Arrhythmia assessment was performed during chemotherapy. Clinical events were documented at each visit. A cohort of patients had rapid sequence cardiac MRI and cardiac myosin binding protein C. The main outcome was change in troponin T between the two groups. Secondary outcomes included LV function, clinical events and arrhythmia outcomes. The relationship between peak troponin and secondary outcomes was assessed in a prospective observational manner. Results: Thirty-seven patients were randomly allocated to the remote ischaemic conditioning (n=19) or sham group (n=18). After excluding withdrawals, 16 patients in each group were included in the intention to treat analysis. Troponin T significantly increases during chemotherapy and peaks 1 month after. Regression analysis shows no difference in troponins between the groups during chemotherapy (mean difference 1.59ng/L, p=0.245) or follow-up (mean difference 0.62ng/L, p=0.744). Clinical events were similar. There was a significant trend towards more admissions with sepsis/neutropenia in the RIC group. There is a moderate correlation between peak troponin and total cumulative dose received (r=0.422, p=0.016) but no correlation with other outcomes. cMyC has a 4-fold median peak increase compared to 2-fold for TnT (p<0.001). Rapid sequence CMR is feasible (mean scanning time 14 minutes) and acceptable (85% acceptance rate). Conclusions: Remote ischaemic conditioning does not reduce anthracycline cardiotoxicity as assessed with troponin T despite a significant rise in troponin from chemotherapy.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | Remote ischaemic conditioning as a cardioprotective mechanism against anthracycline induced cardiac injury and multimodality monitoring of patients receiving anthracycline chemotherapy |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10141546 |
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