From preconditioning to postconditioning: novel interventions in the armory of salvage of the ischemic heart.
نویسندگان
چکیده
T otal coronary occlusion without prior development of collateral circulation results in a wavefront of myocardial necrosis, which moves from subendocardium to subepicardium. The early restoration of flow by pharmacological or mechanical means may interrupt the development of necrosis, saving the jeopardized myocardium. Twenty years ago, experimental studies revealed an endogenous defense mechanism, called ischemic preconditioning. Preconditioning is activated by brief ischemic insults separated by short reperfusion intervals applied prior to long ischemia. In a great number of experimental studies, ischemic preconditioning limited the infarct size in every species, independently of the existence of collaterals. Despite the fact that preconditioning is difficult to apply in clinical practice, because of the undefined conditions for proper activation and the unknown time interval between short and long ischemic periods, there is ample evidence that preconditioning exists in humans and may reduce the infarct size. Preconditioning has also been shown to reduce the incidence of lethal arrhythmias, chest pain, ST elevation, and to confer better post ischemic recovery of the left ventricle. Recent experimental studies in dogs revealed a novel protective mechanism of the heart, which has been termed postconditioning. This mechanism is activated by From Preconditioning to Postconditioning: Novel Interventions in the Armory of Salvage of the Ischemic Heart
منابع مشابه
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ورودعنوان ژورنال:
- Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese
دوره 47 6 شماره
صفحات -
تاریخ انتشار 2006