The DOI matches its Crossref record; 93 of the 93 references it cites were found in a registry or an index.
Critical Issues for the Translation of Cardioprotection
Open accessAbstract
The translation from numerous successful animal experiments on cardioprotection beyond that by reperfusion to clinical practice has to date been disappointing. Animal experiments often use reductionist approaches and are mostly performed in young and healthy animals which lack the risk factors, comorbidities, and comedications which are characteristics of patients suffering an acute myocardial infarction or undergoing cardiovascular surgery. Conceptually, it is still unclear by how much the time window for successful reperfusion is extended by preconditioning, and how long the duration of ischemia can be so that adjunct cardioprotection by postconditioning at reperfusion still protects. Experimental studies addressing long-term effects of adjunct cardioprotection beyond infarct size reduction, that is, on repair, remodeling, and mortality, are lacking. Technically, reproducibility and robustness of experimental studies are often limited. Grave faults in design and conduct of clinical trials have also substantially contributed to the failure of translation of cardioprotection to clinical practice. Cardiovascular surgery with ischemic cardioplegic arrest is only a surrogate of acute myocardial infarction and confounded by the choice of anesthesia, hypothermia, cardioplegia, and traumatic myocardial injury. Trials in patients with acute myocardial infarction have been performed on agents/interventions with no or inconsistent previous animal data and in patients who had either some reperfusion already at admission or were reperfused too late to expect any myocardial salvage. Of greatest concern is the lack of adequate phase II dosing and timing studies when rushing from promising proof-of-concept trials with surrogate end points such as infarct size to larger clinical outcome trials. Future trials must focus on interventions/agents with robust preclinical evidence, have solid phase II dosing and timing data, and recruit patients who have truly a chance to benefit from adjunct cardioprotection.
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Cites
Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium.
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Effect of Cyclosporine on Reperfusion Injury in Acute Myocardial Infarction
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What does research reproducibility mean?
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Reproducibility in Science: Improving the Standard for Basic and Preclinical Research
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Self-citationPostconditioning the Human Heart
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Self-citationRemote Ischemic Preconditioning and Outcomes of Cardiac Surgery
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Cyclosporine before PCI in Patients with Acute Myocardial Infarction
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Cited by
Multitarget Strategies to Reduce Myocardial Ischemia/Reperfusion Injury
Davidson, S. M., Ferdinandy, P., Andreadou, I., Bøtker, H. E., Heusch, G., Ibáñez, B., Ovize, M., Schulz, R., Yellon, D. M., Hausenloy, D. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.09.086 · Cited by 699
Self-citationGuidelines for experimental models of myocardial ischemia and infarction
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Self-citationCoronary microvascular obstruction: the new frontier in cardioprotection
Heusch, G. (2019) · Basic Research in Cardiology · doi:10.1007/s00395-019-0756-8 · Cited by 253
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Metadata
- Authors
- Heusch, G.
- Venue
- Circulation Research
- Published
- 2017-04-28
- Volume
- 120
- Issue
- 9
- Pages
- 1477-1486
- ISSN
- 0009-7330 (ISSN-L)
- 1524-4571
- OpenAlex
- W2609319132
- Cited by
- 293
- References
- 93
- FWCI
- 23.74
- Type
- journal article
- Language
- en
- Open access
- bronze
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