Attenuation of ST-segment elevation after ischemic conditioning maneuvers reflects cardioprotection online

Ischemic conditioning maneuvers, when induced either locally in the heart or remotely from the heart, reduce infarct size. However, infarct size reduction can be assessed no earlier than hours after established reperfusion. ST-segment elevation and its attenuation might reflect cardioprotection by ischemic conditioning online. Pigs were subjected to regional myocardial ischemia/reperfusion (1h/3h). Ischemic conditioning was induced prior to ischemia either locally (preconditioning; IPC; n=15) or remotely (remote preconditioning; RIPC; n=21), remotely during ischemia (remote perconditioning; RPER; n=18), or locally at reperfusion (postconditioning; POCO; n=9). Pigs without conditioning served as controls (PLA; n=29). Area at risk and infarct size were measured postmortem, and ST-segment elevation was analyzed in a V2-like electrocardiogram lead. Ischemic conditioning reduced infarct size (PLA 42 +/- 11% of area at risk; IPC 18 +/- 10%; RIPC 22 +/- 12%; RPER 23 +/- 12%, POCO 22 +/- 11%). With PLA, ST-segment elevation was increased at 5min ischemia, sustained until 55min ischemia and further increased at 10min reperfusion. IPC and RIPC did not impact on ST-segment elevation at 5min ischemia, but attenuated ST-segment elevation at 55min ischemia. With RPER, ST-segment elevation was not different from that with PLA at 5min, but attenuated at 55min ischemia. POCO abolished the further increase of ST-segment elevation with reperfusion. Cardioprotection by ischemic conditioning is robustly reflected by attenuation of ST-segment elevation online.