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Ischemic preconditioning: fact or fantasy?

Christopher D Raeburn1, Michael A Zimmerman, Jyoti Arya

  • 1Department of Surgery, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Box C-305, Denver, CO 80262, USA.

Journal of Cardiac Surgery
|March 20, 2003
PubMed
Summary
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Cardiac preconditioning, a method involving brief ischemia, protects the heart from damage and improves function. This protective strategy is now clinically validated for preventing complications after cardiac surgery and transplantation.

Area of Science:

  • Cardiology
  • Molecular Biology
  • Biochemistry

Background:

  • Protective cardiac preconditioning (PC) influences various cardiac states, from healthy to stunned, hibernating, apoptotic, or necrotic myocardium.
  • Understanding the cellular mechanisms of PC has advanced significantly, enabling clinical translation.

Purpose of the Study:

  • To review the mechanisms and clinical applications of protective cardiac preconditioning.
  • To highlight PC's role in mitigating myocardial infarction, postischemic dysrhythmias, and contractile dysfunction.

Main Methods:

  • Investigated signaling pathways involving adrenergic, adenosine, bradykinin, and opioid receptors.
  • Examined the role of protein kinases (PKC) and mitochondrial ATP-dependent potassium channels.
  • Studied the induction of oxygen radicals and nuclear translocation of transcriptional regulators.

Related Experiment Videos

Main Results:

  • PC activates signaling cascades leading to enhanced cardiomyocyte resilience.
  • PC protects against myocardial infarction, limits postischemic dysrhythmias, and improves contractile function.
  • Phase I and II clinical trials demonstrate the safety and efficacy of pharmacological preconditioning.

Conclusions:

  • Cellular mechanisms of PC are well-understood, paving the way for clinical use.
  • Pharmacological preconditioning is a safe and effective strategy for preventing postcardiac surgical complications.
  • PC is being explored as an adjunct therapy for organ protection during transplantation.