In a study of patients receiving anthracycline-based chemotherapy, a strategy of remote ischemic conditioning (RIC) was not associated with differences in cardiac biomarker levels compared with a sham control. Results were reported in the journal JACC: CardioOncology.1

The single-blind ERIC-ONC study (Effect of Remote Ischaemic Conditioning in Oncology Patients; Identifier: NCT02471885) enrolled patients aged 16 to 80 years who were receiving anthracycline-based therapy for any cancer type. Patients were randomly assigned 1:1 to either an RIC group or a sham-treatment group. RIC was applied through pressure changes using a blood pressure cuff.

The primary study endpoint was the level of troponin T (TnT), measured for a maximum of 1 year after chemotherapy. Cardiac function, major adverse cardiovascular events (MACE), and death related to MACE or cancer were secondary outcomes. Cardiac myosin-binding protein C (cMyC) levels were also evaluated.

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A total of 60 patients were recruited, but the study was stopped due to the COVID-19 pandemic after analyses of 55 patients, including 28 in the RIC group and 27 in the sham group. Mean patient ages were 49 years in each group, but 54% of patients in the RIC group had metastatic disease, compared with 37% in the sham group.

From baseline to chemotherapy cycle 6, the median TnT level had risen from 6 ng/L to 33 ng/L in the population overall. Between treatment groups across time points, median TnT values were similar, with a mean difference of 3.15 ng/L (95% CI, −0.04 to 6.33), for RIC compared with sham; this was not a statistically significant difference (P =.053). Patterns for cMyC were reportedly similar to those seen with TnT.

Deaths occurred more among patients in the RIC group than in the sham group. There were 11 deaths related to MACE or cancer in the RIC group, compared with 3 in the sham group (hazard ratio [HR], 0.25; 95% CI, 0.07-0.899; P =.034). Cancer-related deaths at 1 year totaled 8 in the RIC group and 1 in the sham group (HR, 0.21; 95% CI, 0.04-0.95; P =.043).

The study investigators concluded that the evaluated cardiac biomarkers were not different between the treatment groups, but there was a tendency for earlier cancer-related deaths in the RIC group. “The premature, forced termination of the study and the imbalance of cancer severity at randomization preclude a robust interpretation of these clinical events,” the investigators wrote in their report.


Mallouppas M, Chung R, Ghosh AK, Macklin A, Yellon DM, Walker JM. Anthracyclines and biomarkers of myocardial injury: the effect of remote ischemic conditioning (RIC). JACC. CardioOncol. Published online May 9, 2023. doi:10.1016/j.jaccao.2023.03.008