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(Circulation. 1998;97:1211-1212.)
© 1998 American Heart Association, Inc.

Correspondence

Effects of Ischemic Preconditioning

Dirk J. Duncker, MD, PhD; ; Pieter D. Verdouw, PhD

Experimental Cardiology, Thoraxcenter, Erasmus University Rotterdam, Rotterdam, The Netherlands

To the Editor:

The clinical existence and relevance of ischemic preconditioning will remain difficult to prove because patients cannot be subjected to the rigorous protocols performed in laboratory animals and because of our inability to accurately determine infarct size and its determinants in humans. Furthermore, the presence of atherosclerotic lesions in coronary arteries can result in intermittent/chronic ischemia that could result in tolerance to the ischemic stimulus.¹ Consequently, investigating the phenomenon of ischemic preconditioning in animal models that mimic the clinical situation is important. It was therefore with great interest that we read the article by Kapadia et al² in which they describe that the protective effect of ischemic preconditioning is not abolished in the presence of a critical stenosis. Although this study in a closed chest swine model is another major step forward in bridging the gap between the laboratory and the clinical setting, there are a number of issues that deserve comment.

The authors did not find a protective effect of the stenosis alone, which reduced blood flow by approximately 35% (P=NS), and indicated that this finding is at variance with the results of a study from our laboratory in which we showed that 30-minute 70% flow reduction resulted in a reduction of infarct size produced by 60 minutes of coronary artery occlusion.³ However, in a subsequent study⁴ we demonstrated that when flow was reduced by only 30% for up to 90 minutes immediately preceding the 60 minutes of total coronary occlusion, cardioprotection was absent. Furthermore, . . . [Full Text of this Article]

Albert S. Most, MD; ; Joseph S. Terlato, MD

Department of Medicine, Rhode Island Hospital, Providence, RI

Shaival J. Kapadia, MD

Richmond, Va