Cardioprotection: chances and challenges of its translation to the clinic
Myocardial infarct size is a major determinant of prognosis. Ischaemic preconditioning with brief coronary occlusion and reperfusion before a sustained period of coronary occlusion with reperfusion delays infarct development. Ischaemic postconditioning uses repetitive brief coronary occlusion during...
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| Veröffentlicht in: | The Lancet (British edition) 2013-01, Vol.381 (9861), p.166-175 |
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| description | Myocardial infarct size is a major determinant of prognosis. Ischaemic preconditioning with brief coronary occlusion and reperfusion before a sustained period of coronary occlusion with reperfusion delays infarct development. Ischaemic postconditioning uses repetitive brief coronary occlusion during early reperfusion of myocardial infarction and reduces infarct size. Remote ischaemic preconditioning uses brief ischaemia and reperfusion of a distant organ to protect the myocardium. These conditioning protocols recruit a complex signal cascade of sarcolemmal receptor activation, intracellular enzyme activation, and ultimately mitochondrial stabilisation and inhibition of death signalling. Conditioning protocols have been successfully used in patients undergoing elective coronary revascularisation and reperfusion after acute myocardial infarction. Pharmacological recruitment of cardioprotective signalling has also been used to reduce infarct size, but so far without prognostic benefit. Outcomes of cardioprotection are affected by age, sex, comorbidities, and drugs, but also by technical issues related to determination of infarct size and revascularisation procedure. |
| doi_str_mv | 10.1016/S0140-6736(12)60916-7 |
| format | Article |
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Ischaemic preconditioning with brief coronary occlusion and reperfusion before a sustained period of coronary occlusion with reperfusion delays infarct development. Ischaemic postconditioning uses repetitive brief coronary occlusion during early reperfusion of myocardial infarction and reduces infarct size. Remote ischaemic preconditioning uses brief ischaemia and reperfusion of a distant organ to protect the myocardium. These conditioning protocols recruit a complex signal cascade of sarcolemmal receptor activation, intracellular enzyme activation, and ultimately mitochondrial stabilisation and inhibition of death signalling. Conditioning protocols have been successfully used in patients undergoing elective coronary revascularisation and reperfusion after acute myocardial infarction. Pharmacological recruitment of cardioprotective signalling has also been used to reduce infarct size, but so far without prognostic benefit. 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Ischaemic preconditioning with brief coronary occlusion and reperfusion before a sustained period of coronary occlusion with reperfusion delays infarct development. Ischaemic postconditioning uses repetitive brief coronary occlusion during early reperfusion of myocardial infarction and reduces infarct size. Remote ischaemic preconditioning uses brief ischaemia and reperfusion of a distant organ to protect the myocardium. These conditioning protocols recruit a complex signal cascade of sarcolemmal receptor activation, intracellular enzyme activation, and ultimately mitochondrial stabilisation and inhibition of death signalling. Conditioning protocols have been successfully used in patients undergoing elective coronary revascularisation and reperfusion after acute myocardial infarction. Pharmacological recruitment of cardioprotective signalling has also been used to reduce infarct size, but so far without prognostic benefit. Outcomes of cardioprotection are affected by age, sex, comorbidities, and drugs, but also by technical issues related to determination of infarct size and revascularisation procedure.</description><subject>Biological and medical sciences</subject><subject>Cardiotonic Agents - therapeutic use</subject><subject>comorbidity</subject><subject>death</subject><subject>drugs</subject><subject>enzyme activation</subject><subject>General aspects</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>infarction</subject><subject>Internal Medicine</subject><subject>Ischemic Preconditioning, Myocardial - methods</subject><subject>Medical sciences</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Ischemia - complications</subject><subject>Myocardial Reperfusion Injury - prevention & 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| subjects | Biological and medical sciences Cardiotonic Agents - therapeutic use comorbidity death drugs enzyme activation General aspects Heart Heart attacks Humans infarction Internal Medicine Ischemic Preconditioning, Myocardial - methods Medical sciences Myocardial infarction Myocardial Infarction - complications Myocardial Ischemia - complications Myocardial Reperfusion Injury - prevention & control myocardium patients prognosis recruitment Rodents Signal Transduction Studies |
| title | Cardioprotection: chances and challenges of its translation to the clinic |
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