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Current Enzyme Inhibition

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*

DOI: 10.2174/1573408015666190906120640

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Application of Remote Ischemic Preconditioning in Patients Undergoing Chemotherapy with Anthracyclines

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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.

Keywords: Anthracyclines, cardiotoxicity, chemotherapy, neoplasia, remote ischemic preconditioning, troponin T.

Graphical Abstract

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