Preconditioning in the Heart

Abstract

Ischaemic heart disease (IHD) is the leading cause of death and disability worldwide. The pathophysiological effects of IHD often arise as a direct result of the detrimental effects of acute ischaemia-reperfusion injury (IRI) on the myocardium. Therefore, novel therapeutic strategies need to be identified to protect the myocardium against acute IRI, preserve cardiac function and improve clinical outcomes in patients with IHD. In this regard, ischaemic preconditioning (IPC) describes an endogenous cardioprotective phenomenon in which the heart is rendered resistant to a sustained episode of lethal IRI by subjecting it to a brief episode of non-lethal ischaemia and reperfusion. IPC as a concept has evolved over the years into a variety of different forms (collectively termed ischaemic conditioning), in which the protective stimulus is applied either directly to the heart or indirectly to an organ or tissue away from the heart (remote ischaemic conditioning) and can be applied either prior to or after the onset of myocardial ischaemia and even at the onset of myocardial reperfusion. This chapter provides an overview of these different forms of ischaemic conditioning, the underlying mechanisms involved and their potential clinical application for patients with IHD.