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J Am Coll Cardiol. 2015 Jan 20;65(2):177-95. doi: 10.1016/j.jacc.2014.10.031.

Remote ischemic conditioning.

Author information

1
Institute for Pathophysiology, West German Heart and Vascular Centre Essen, University of Essen Medical School, Essen, Germany. Electronic address: gerd.heusch@uk-essen.de.
2
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
3
Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, Michigan.
4
Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
5
The Hatter Cardiovascular Institute, University College London, London, United Kingdom.

Abstract

In remote ischemic conditioning (RIC), brief, reversible episodes of ischemia with reperfusion in one vascular bed, tissue, or organ confer a global protective phenotype and render remote tissues and organs resistant to ischemia/reperfusion injury. The peripheral stimulus can be chemical, mechanical, or electrical and involves activation of peripheral sensory nerves. The signal transfer to the heart or other organs is through neuronal and humoral communications. Protection can be transferred, even across species, with plasma-derived dialysate and involves nitric oxide, stromal derived factor-1α, microribonucleic acid-144, but also other, not yet identified factors. Intracardiac signal transduction involves: adenosine, bradykinin, cytokines, and chemokines, which activate specific receptors; intracellular kinases; and mitochondrial function. RIC by repeated brief inflation/deflation of a blood pressure cuff protects against endothelial dysfunction and myocardial injury in percutaneous coronary interventions, coronary artery bypass grafting, and reperfused acute myocardial infarction. RIC is safe and effective, noninvasive, easily feasible, and inexpensive.

KEYWORDS:

acute myocardial infarction; coronary artery bypass grafting; myocardial ischemia; reperfusion

PMID:
25593060
PMCID:
PMC4297315
DOI:
10.1016/j.jacc.2014.10.031
[Indexed for MEDLINE]
Free PMC Article

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