Myocardial conditioning: opportunities for clinical translation

Area of Science:

• Cardiology
• Cardioprotection
• Translational Medicine

Background:

• Myocardial conditioning is an endogenous cardioprotective process that reduces infarct size in experimental settings.
• Translating these protective strategies from laboratory research to clinical practice remains a significant challenge.

Purpose of the Study:

• To critically review the progress, opportunities, and challenges in the clinical translation of postconditioning and remote conditioning.
• To summarize the current evidence for these two conditioning strategies in patient care.

Main Methods:

• Review of phase II and ongoing phase III clinical trials.
• Analysis of patient selection, application timing, and endpoint assessment for conditioning strategies.
• Evaluation of efficacy data for postconditioning and remote conditioning in various clinical scenarios.

Main Results:

• Phase II studies suggest postconditioning reduces infarct size by approximately 35% in ST-segment-elevation myocardial infarction patients.
• Remote conditioning has been applied in planned procedures and ST-segment-elevation myocardial infarction patients, but efficacy data show controversies.
• Heterogeneity in study designs and a lack of understanding of influencing factors contribute to disparate outcomes for remote conditioning.

Conclusions:

• Postconditioning and remote conditioning hold potential as clinically relevant cardioprotective strategies.
• Successful implementation requires careful patient selection, timely intervention, and appropriate endpoint assessment.
• Further insights into the efficacy and application of these conditioning methods are expected from ongoing phase III trials.