Title:Application of Remote Ischemic Preconditioning in Patients Undergoing Chemotherapy with Anthracyclines
VOLUME: 15 ISSUE: 2
Author(s):Simone Meneghetti Zatta, Neif Murad, Beatriz da Costa Aguiar Alves, Ligia Ajaime Azzalis, Virginia Berlanga Campos Junqueira, Roberto Odebrecht Rocha, Marcelo Rodrigues Bacci, David Feder, Antonio Carlos Palandri Chagas, Fernando Adami and Fernando Luiz Affonso Fonseca*
Affiliation:Serviço de Oncologia, Hospital Santa Marcelina, São Paulo, SP, Centro Universitário Saúde ABC/ Faculdade de Medicina do ABC, Santo André, SP, Centro Universitário Saúde ABC/ Faculdade de Medicina do ABC, Santo André, SP, Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo, Diadema, SP, Departamento de Ciências Farmacêuticas, Universidade Federal de São Paulo, Diadema, SP, Serviço de Oncologia, Hospital Santa Marcelina, São Paulo, SP, Centro Universitário Saúde ABC/ Faculdade de Medicina do ABC, Santo André, SP, Centro Universitário Saúde ABC/ Faculdade de Medicina do ABC, Santo André, SP, Centro Universitário Saúde ABC/ Faculdade de Medicina do ABC, Santo André, SP, Centro Universitário Saúde ABC/ Faculdade de Medicina do ABC, Santo André, SP, Centro Universitário Saúde ABC/ Faculdade de Medicina do ABC, Santo André, SP
Keywords:Anthracyclines, cardiotoxicity, chemotherapy, neoplasia, remote ischemic preconditioning, troponin T.
Abstract:Background: The most active agents for the treatment of breast cancer are the anthracyclines
whose clinical usefulness is limited by cumulative dose-dependent cardiotoxicity, which results
in congestive heart failure among other limiting factors. With all the attempts to minimize
chemotherapeutic cardiotoxicity, remote ischemic preconditioning (RIPC) has been considered as a
potent endogenous mechanism capable of inhibiting inflammatory responses.
Objective: This study aimed to verify if RIPC may be effective as prophylaxis to prevent anthracycline-
induced cardiotoxicity in oncological patients.
Methods: The preconditioning method was based on four to five-minute cycles of a blood pressure
cuff insufflation around the upper arm (either left or right) from 200 mmHg to 250 mmHg, inducing
ischemic intervals interspersed with 5 minutes of reperfusion.
Results: In this work, echocardiogram results showed a ventricular mass variation that can get worse
during chemotherapeutic treatment; however, in patients who had been undergoing RIPC sessions
over a period of 6 months, it was observed that this change did not occur. The parameters for troponin
T levels were considered; they were higher in patients who were not undergoing RIPC in relation
to those who were. When both cases were compared, it was possible to infer that there was a
clinically significant improvement for those who went through the procedure.
Conclusion: Thus, through the analysis of this study, it is possible to conclude that RIPC is a lowcost,
non-invasive procedure which brings cardiac protection for patients undergoing chemotherapy
with anthracyclines, providing support in the treatment of cancer.