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Perioperative Cardioprotection: General Mechanisms and Pharmacological Approaches
Carolin Torregroza1,2, Annika Raupach1, Katharina Feige1
1From the Department of Anesthesiology, University Hospital Duesseldorf, Duesseldorf, Germany.
Insights
Cardioprotection strategies shield the heart from myocardial infarction injury. Pharmacological mimics of ischemic conditioning offer promising, less invasive clinical applications for heart protection.
Area of Science:
- Cardiology
- Pharmacology
- Cellular Biology
Background:
- Myocardial infarction causes heart injury, and reperfusion, while vital, can paradoxically worsen damage (ischemia/reperfusion injury).
- Effective cardioprotection strategies are crucial to minimize heart damage during and after myocardial infarction.
- Ischemic preconditioning and postconditioning are potent cardioprotective methods but are clinically impractical due to invasiveness.
Purpose of the Study:
- To review fundamental mechanisms of cardiac conditioning strategies.
- To provide an overview of recent findings in experimental cardioprotection.
- To emphasize pharmacological approaches for perioperative cardioprotection.
Main Methods:
- Review of scientific literature on cardioprotection mechanisms.
- Analysis of experimental findings on various cardioprotective concepts.
- Focus on pharmacological agents mimicking ischemic conditioning.
Main Results:
- Ischemic preconditioning and postconditioning are effective but invasive.
- Pharmacological agents like volatile anesthetics, noble gases, opioids, propofol, dexmedetomidine, and phosphodiesterase inhibitors can mimic conditioning effects.
- These agents are clinically used and show promise for translating cardioprotection to clinical trials.
Conclusions:
- Pharmacological mimicry of ischemic conditioning presents a viable strategy for clinical cardioprotection.
- The reviewed agents offer promising avenues for protecting the heart in perioperative settings.
- Further clinical translation of these experimental findings is warranted.
Abstract:
Cardioprotection encompasses a variety of strategies protecting the heart against myocardial injury that occurs during and after inadequate blood supply to the heart during myocardial infarction. While restoring reperfusion is crucial for salvaging myocardium from further damage, paradoxically, it itself accounts for additional cell death-a phenomenon named ischemia/reperfusion injury. Therefore, therapeutic strategies are necessary to render the heart protected against myocardial infarction. Ischemic pre- and postconditioning, by short periods of sublethal cardiac ischemia and reperfusion, are still the strongest mechanisms to achieve cardioprotection. However, it is highly impractical and far too invasive for clinical use. Fortunately, it can be mimicked pharmacologically, for example, by volatile anesthetics, noble gases, opioids, propofol, dexmedetomidine, and phosphodiesterase inhibitors. These substances are all routinely used in the clinical setting and seem promising candidates for successful translation of cardioprotection from experimental protocols to clinical trials. This review presents the fundamental mechanisms of conditioning strategies and provides an overview of the most recent and relevant findings on different concepts achieving cardioprotection in the experimental setting, specifically emphasizing pharmacological approaches in the perioperative context.
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