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Cardiovascular Research Advance Access originally published online on April 27, 2009
Cardiovascular Research 2009 83(2):234-246; doi:10.1093/cvr/cvp129
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Protective ischaemia in patients: preconditioning and postconditioning

Asger Granfeldt1, David J. Lefer2 and Jakob Vinten-Johansen2,*

1 Department of Anesthesiology and Critical Care, Aarhus University, Aarhus, Denmark
2 Cardiothoracic Research Laboratory, Carlyle Fraser Heart Center, Emory Crawford Long Hospital, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308-2225, USA

* Corresponding author. Tel: +1 404 686 2511; fax: +1 404 686 4888. E-mail address: jvinten{at}emory.edu

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.

KEYWORDS Preconditioning; Postconditioning; Infarct size; Myocardial protection; Coronary intervention; Cardiac surgery

Time for primary review: 23 days


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