Ischemic and Postischemic Conditioning of the Myocardium in Clinical Practice: Challenges, Expectations and Obstacles

Conditioning refers to endogenous mechanisms rendering the myocardium more tolerant against reperfusion injury. Application of brief ischemia-reperfusion cycles prior to the index ischemia has a beneficial effect and limits the infarct size. This is called preconditioning and is mainly mediated by activation of adenosine, bradykinin, opioid and other receptors, with subsequent activation of intracellular mediators leading to mitochondrial protection. A clinical equivalent of preconditioning is preinfarction angina. Benefits for the ischemic and reperfused myocardium are also provided by repetitive short-lived cycles of ischemia-reperfusion applied after the index ischemia. This is termed postconditioning, shares a common pathway with preconditioning, and is more useful and relevant in clinical practice. Finally, benefits are also derived from remote conditioning, i.e. ischemia applied in a remote vascular territory parallel with or immediately after the index myocardial ischemia. Several pharmacological interventions may interfere with these mechanisms leading to enhanced protection of the myocardium Received: March 12, 2014 Accepted after revision: March 27, 2014 Published online: September 10, 2014 Efstathios K. Iliodromitis, MD Second Department of Cardiology, Medical School Attikon University Hospital, Rimini 1, Haidari GR–12462 Athens (Greece) E-Mail iliodromitis @ yahoo.gr © 2014 S. Karger AG, Basel 0008–6312/14/1292–0117$39.50/0