Protective Effect of Remote Ischemic Preconditioning against Myocardial Ischemia-Reperfusion Injury in Rats and Mice: A Systematic Review and Meta-Analysis

Fig. 1.. Prisma chart flow. A total of 594 studies were identified from Pubmed, Web of Science, Embase, and Cochrane library. After assessed of eligibility, 37 articles were included in the quantitative synthesis.

Fig. 2.. Forest plots of infarct size in random effect size analysis. High heterogeneity was observed, and the infarct size in the RIPC group was significantly lower than in the control group. RIPC, remote Ischemic preconditioning; CI, confidence interval; SMD, standardized mean difference.

Fig. 3.. Assessment of publication bias by Funnel plot. The dotted line indicated the standardized mean difference (SMD). The funnel plot was unsymmetric and indicated the existence of publication bias. SMD, standardized mean difference.

Fig. 4.. Sensitivity analysis. The round shape represented the estimated pooled effect when a given named study was omitted. The vertical line indicated the lower and upper confidence interval (CI) limit.

Fig. 5.. Forest plots of Serum cardiac markers. RIPC was related to significantly lower cTNI levels in MIRI. No significant difference was observed in LDH, CK-MB, and cTNT between the two groups. RIPC, remote Ischemic preconditioning; MIRI, myocardial ischemia-reperfusion injury; CI, confidence interval; CK, creatine kinase; cTNI, cardiac troponin I; cTNT, cardiac troponin T; LDH, lactate dehydrogenase; SMD, standardized mean difference.

Fig. 6.. Forest plots of vital signs. No significant difference was observed in HR, MAP and RPP. HR, heart rate; MAP, mean arterial pressure; RPP, heart rate-blood pressure product.

Fig. 7.. Forest plots of hemodynamic parameters. LVDP, recovery of LVDP, dp/dt max, and dp/dt min were significantly higher in the RIPC group. No significant difference was observed in LVSP, LVEDP, CF, and VT/VF between the two groups. RIPC, remote Ischemic preconditioning; CI, confidence interval; SMD, standardized mean difference; CF, coronary flow; LVDP, left ventricular developed pressure; LVEDP, left ventricular end diastolic pressure; LVSP, left ventricular systolic pressure; VT, ventricular tachycardia; VF, ventricular fibrillation.

Fig. 8.. Forest plots of the TUNEL-positive cells. TUNEL-positive cells in the RIPC group were significantly less compared with the control group in MIRI animals. RIPC, remote Ischemic preconditioning; CI, confidence interval; MIRI, myocardial ischemia-reperfusion injury; SMD, standardized mean difference.