Protective ischaemia in patients: preconditioning and postconditioning

Infarct size can be limited by reducing the determinants of infarct size or increasing collateral blood flow by treatment initiated before the ischaemic event. Reperfusion is the definitive treatment for permanently reducing infarct size and restoring some degree of contractile function to the affec...

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Bibliographic Details
Published in:Cardiovascular research 2009-07, Vol.83 (2), p.234-246
Main Authors: Granfeldt, Asger, Lefer, David J., Vinten-Johansen, Jakob
Format: Article
Language:English
Subjects:
Animals
Cardiac surgery
Cardiovascular Agents - therapeutic use
Cell Survival
Coronary intervention
Humans
Infarct size
Ischemic Preconditioning, Myocardial
Myocardial Infarction - etiology
Myocardial Infarction - pathology
Myocardial Infarction - prevention & control
Myocardial Ischemia - complications
Myocardial Ischemia - pathology
Myocardial Ischemia - therapy
Myocardial protection
Myocardial Reperfusion Injury - etiology
Myocardial Reperfusion Injury - pathology
Myocardial Reperfusion Injury - prevention & control
Myocardium - pathology
Postconditioning
Preconditioning
Reviews
Treatment Outcome
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Summary:Infarct size can be limited by reducing the determinants of infarct size or increasing collateral blood flow by treatment initiated before the ischaemic event. Reperfusion is the definitive treatment for permanently reducing infarct size and restoring some degree of contractile function to the affected myocardium. Innate survival mechanisms in the heart can be stimulated by short, non-lethal periods of ischaemia and reperfusion, applied either before or after the ischaemic event. Preconditioning, a series of transient intervals of ischaemia and reperfusion applied before the lethal ‘index’ ischaemic event, sets in motion molecular and cellular mechanisms that increase cardiomyocyte survival to a degree that had not hitherto been seen before. The cardioprotective ischaemic-reperfusion protocol applied at onset of reperfusion, termed ‘postconditioning’ (Postcon), is also associated with significant cardioprotection that can be applied at the point of reperfusion treatment in the catheterization laboratory or operating room. Both preconditioning and Postcon have been successfully applied to the clinical setting and have been found to reduce infarct size and other attributes of post-ischaemic injury. This review will summarize the physiological preclinical data on preconditioning and Postcon that are relevant to their translation to clinical therapeutics and treatment.
ISSN:0008-6363
1755-3245
DOI:10.1093/cvr/cvp129