Fig. 7.

Effect of remote ischemic preconditioning (RIPC) on left ventricular ejection fraction (LVEF) and mitochondrial structure in a pig model of anthracycline cardiotoxicity. Pigs received five biweekly intracoronary doxorubicin injections with RIPC of control applied before each injection. Serial cardiac magnetic resonance imaging studies were performed during 4 months follow-up. Anthracycline-induced systolic dysfunction was significantly attenuated in pigs receiving RIPC. At the ultrastructural level, mitochondria were fragmented in pigs receiving doxorubicin since subclinical stages (i.e. a time where cardiac function was still normal). At late stages (i.e. when severe cardiac dysfunction was present), mitochondria were severely damaged (electrodense and ultra-fragmented). Mitochondria from pigs undergoing RIPC before each anthracycline administration were much more preserved at every timepoint. Figure adapted from [299].