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(Circulation. 2005;111:120-121.)
© 2005 American Heart Association, Inc.

Editorial

We Think We See a Pattern Emerging Here

James M. Downey, PhD; Michael V. Cohen, MD

From the Departments of Physiology (J.M.D., M.V.C.) and Medicine (M.V.C.), University of South Alabama College of Medicine, Mobile.

Correspondence to James M. Downey, PhD, Dept of Physiology, MSB 3074, University of South Alabama College of Medicine, Mobile, AL 36688. E-mail jdowney@usouthal.edu

Key Words: Editorials • myocardium • ischemia • occlusion • infarction

An extract of the first 250 words of the full text is provided, because this article has no abstract.

For more than 30 years, the quest for interventions that can preserve viability in ischemic myocardium has been ongoing. The search began with the pioneering studies of Maroko and colleagues in the 1970s.¹ Although reperfusion therapy has emerged as a great success story, we are still on a quest for an intervention that can preserve viability until blood flow can be restored in the setting of acute myocardial infarction. This field has progressed along 3 distinct lines.

See pp 173 and 194

The first line was ischemic preconditioning, initially described by Charles Murry,² working with Keith Reimer and Robert Jennings at Duke University. It was noted that infarct size in dogs was much smaller if hearts were preconditioned with a series of short coronary artery occlusions before a sustained 40-minute occlusion. This seemed paradoxical because the preconditioned hearts actually had undergone 20 additional minutes of ischemia. We now know that the preconditioning ischemia sets in motion a complex cascade of signal transduction events that ultimately modify the cardiomyocytes to make them resistant to infarction. As these signal transduction pathways were elucidated, more and more opportunities for pharmacological intervention were revealed. Now it is relatively easy to pharmacologically precondition the heart, but there is one huge drawback with preconditioning: The heart must be preconditioned before the lethal ischemic insult, thus precluding this approach from clinical application in acute myocardial infarction when patients present unannounced after onset of the ischemic process.

A treatment was needed that would protect the heart even when . . . [Full Text of this Article]

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