9th Hatter Biannual Meeting: position document on ischaemia/reperfusion injury, conditioning and the ten commandments of cardioprotection.
9th Hatter Biannual Meeting: position document on ischaemia/reperfusion injury, conditioning and the ten commandments of cardioprotection.
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DOI：
10.1007/s00395-016-0558-1
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发表时间：
2016-07
影响因子：
9.5
通讯作者：
Yellon DM
中科院分区：
文献类型：
--
作者：
Bell RM;Bøtker HE;Carr RD;Davidson SM;Downey JM;Dutka DP;Heusch G;Ibanez B;Macallister R;Stoppe C;Ovize M;Redington A;Walker JM;Yellon DM
在缺血预处理的最初描述后的30年里，对缺血/再灌注损伤的病理生理学和心脏保护概念的理解已经发生了革命性的变化。在同一时期，冠状动脉疾病患者的管理也发生了变化：冠状动脉和瓣膜手术现在被认为是常规的，通常具有良好的结局，急性冠状动脉综合征的管理已经看到了十年来心血管死亡率的下降。然而，尽管有这些改善，心血管疾病和缺血性心脏病，特别是，仍然是世界范围内死亡的主要原因和长期发病率的重要原因（伴随着心力衰竭发病率的增加）。对有效的心脏保护策略的需求从未如此紧迫。然而，尽管动物模型中存在缺血/再灌注的明确证据为人体研究提供了有力的依据，但最近研究心脏手术和急性ST段抬高心肌梗死中各种心脏保护策略的III期临床试验提供了混合结果。Hatter心血管研究所研讨会上的研究人员描述了将强有力的临床前数据转化为有效的临床干预策略的挑战，在这些患者中，有效的药物治疗已经改变了缺血/再灌注损伤的病理生理学，并为未来的基础和临床研究制定了一个明确的框架，以提高在人类中成功转化强有力的临床前干预措施的机会。
In the 30 years since the original description of ischaemic preconditioning, understanding of the pathophysiology of ischaemia/reperfusion injury and concepts of cardioprotection have been revolutionised. In the same period of time, management of patients with coronary artery disease has also been transformed: coronary artery and valve surgery are now deemed routine with generally excellent outcomes, and the management of acute coronary syndromes has seen decade on decade reductions in cardiovascular mortality. Nonetheless, despite these improvements, cardiovascular disease and ischaemic heart disease in particular, remain the leading cause of death and a significant cause of long-term morbidity (with a concomitant increase in the incidence of heart failure) worldwide. The need for effective cardioprotective strategies has never been so pressing. However, despite unequivocal evidence of the existence of ischaemia/reperfusion in animal models providing a robust rationale for study in man, recent phase 3 clinical trials studying a variety of cardioprotective strategies in cardiac surgery and acute ST-elevation myocardial infarction have provided mixed results. The investigators meeting at the Hatter Cardiovascular Institute workshop describe the challenge of translating strong pre-clinical data into effective clinical intervention strategies in patients in whom effective medical therapy is already altering the pathophysiology of ischaemia/reperfusion injury—and lay out a clearly defined framework for future basic and clinical research to improve the chances of successful translation of strong pre-clinical interventions in man.