Delayed Preconditioning And Adaptive Cardioprotection

Interest in the ability of myocardium to adapt to ischaemic stress has continued to grow since the discovery of ischaemic preconditioning in 1986. In 1993, two reports heralded the recognition of a delayed preconditioning response in the heart, now commonly known as the `second window' of protection. Since then, a number of studies have described the ability of delayed preconditioning and related adaptive phenomena to protect against a variety of pathologies in the ischaemic and reperfused myocardium. Our understanding of the cellular mechanisms of sub-acute adaptive cardioprotection has advanced considerably during this period. This compilation of state-of-the-art reviews by those who have made significant contributions to this field provides detailed and critical analysis of this research, from molecular basis to potential clinical relevance. The book aims to provide an authoritative, comprehensive and thoroughly up-to-date overview for scientists and clinicians engaged in, or observing, this rapidly-developing area of heart research. It will also be of interest to those engaged in research on other tissues where ischaemia-reperfusion pathology is of major concern.

Coronary heart disease (CHD) is the leading cause of death worldwide with 3.8 million men and 3.4 million women dying each year. Cardioprotection refers to the prevention of CHD and the clinical improvement in patients suffering from cardiovascular problems. This book focuses on the role of cardioprotection in surgery and the use of pharmacological therapies such as ACE-inhibitors, statins and beta-blockers in order to reduce the myocardial injury sustained by the patient and the significant risk of morbidity and mortality. It includes new cardioprotective strategies aimed at improving the clinical outcomes of patients in these settings, as well as current well-established methods for reducing myocardial injury in acute coronary syndrome patients.

Effective new treatments of heart disease are based on a refined understanding of cellular function and the heart's response to environmental stresses. Not surprisingly therefore, the field of experimental cardiology has experienced a phase of rapid expo nential growth during the last decade. The acquisition of new knowledge has been so fast that textbooks of cardiology or textbooks of cardiovascular physiology are often hard-pressed to keep up with the most important conceptual advances. Witness the explosive increase in knowledge about signaling pathways of cardiac growth, transcrip tional regulation of cardiac metabolism, hormonal signaling, and the complex responses of the heart to ischemia, reperfusion, or ischemic preconditioning. This book is meant to bridge the gap between original literature and textbook reviews. It brings together inves tigators of various backgrounds who share their expertise in the biology of myocardial ischemia. Each chapter is a self-contained mini-review, but it will soon become apparent to the reader that there is also a common thread: Molecular and cellular cardiology has never been more exciting than now, but ever more exciting times are yet to come. The Editors ACKNOWLEDGEMENTS - Publication of this book was generously supported by Sanofi-Aventis Hellas. - Eikon creative team provided the technical assistance in preparing the manuscripts. - We thank Dr. Bernard Swynghedauw for all his scientific support.

Myocardial ischemic syndromes pose a major medical problem and a significant economic health care concern. Reperfusion, although used in the clinical arena as essential to the survival of acutely ischemic heart muscle carries with it the risk of "reperfusion injury". Therefore the salvage of additional myocardium is highly desirable. Over a decade ago, it was shown that whole body heat shock activated a powerful endogenous protective mechanism that significantly improved myocardial salvage following prolonged ischemia and reperfusion injury in the heart. A characteristic feature of this heat shock response was the expression of a family of proteins known as heat shock proteins. Many of these proteins function as molecular chaperones, helping to refold proteins denatured as a consequence of lethal injuries and facilitating the synthesis of new proteins to replace those irreparably damaged. Altered expression of these proteins has been extensively documented in association with a diverse array of diseases such as ischemia and perfusion injury, cardiac hypertrophy, fever, inflammation, metabolic diseases, infection, cell and tissue trauma, aging, and cancer. Interestingly, some studies have now shown a direct correlation of the heat shock proteins produced and the degree of myocardial protection. This book is a thorough description of the current state of knowledge of the mechanisms of heat shock proteins induced cardiac protection at the cellular and molecular level, the controversies in this growing field and the potential of treating ischemic heart disease with overexpression of heat shock proteins in patients. The book will be especially useful for investigators interested in studying tissue injury and its protection with the overexpression of heat shock proteins.

Whenever the heart is challenged with an increased work load for a prolonged period, it responds by increasing its muscle mass--a phenomenon known as cardiac hypertrophy. Although cardiac hypertrophy is commonly seen under physiological conditions such as development and exercise, a wide variety of pathological situa tions such as hypertension (pressure overload), valvular defects (volume overload), myocardial infarction (muscle loss), and cardiomyopathy (muscle disease) are also known to result in cardiac hypertrophy. Various hormones such as catecholamines, thyroid hormones, angiotensin II, endothelin, and growth factors have also been shown to induce cardiac hypertrophy. Although the exact mechanisms underlying or pathological forrns of cardiac hypertrophy are poorly under the physiological stood, an increase in the intraventricular pressure is believed to represent the major stimulus for the development of cardiac hypertrophy. In this regard, stretching of the cardiac muscle has been shown to induce the hypertrophic response, but the role of metabolic influences in this process cannot be ruled out. Furthermore, different hormones and other interventions in the absence of stretch have been observed to stimulate protein synthesis in both isolated cardiomyocyte and vascular myocyte preparations. Nonetheless, it is becoming dear that receptor as well as phospholipid linked signal transduction pathways are activated in some specific manner depend ing upon the initial hypertrophic stimulus, and these then result in an increase in the size and mass of cardiomyocytes.

In the era of instant global communication, medicine is an international discipline characterized by a wide range of patient referral systems, world-wide discussion of clinical and research findings, and an explosion in the medical literature. Perhaps no field has progressed more than cardiology in the past few years. Contemporary Concepts in Cardiology has been conceived as a supplement to the classic cardiology textbooks for the use of practicing physicians, cardiologists-in-training, medical students, and research investigators. This volume focuses on associations between refinements in the understanding of disease and clinical applications. The material is presented in a way that limns the latest advances and focuses thinking towards future developments in cardiology. The Editors have assembled a respected international panel of contributors so that each chapter is authored by a well-known specialist in his or her field. Every attempt was made to avoid the fragmentation which often characterizes the digest approach. Because the constant flow of information makes it nearly impossible to construct a timely book on advances in cardiology, the chapters in this volume describe the current concepts in cardiology and their underlying rationale, rather than attempting a comprehensive review of the most recent papers in each discipline.

This book reports innovations in the preclinical study of stroke, including - novel tools and findings in animal models of stroke, - novel biochemical mechanisms through which ischemic damage may be both generated and limited, - novel pathways to neuroprotection. Although hypothermia has been so far the sole "neuroprotection" treatment that has survived the translation from preclinical to clinical studies, progress in both preclinical studies and in the design of clinical trials will hopefully provide more and better treatments for ischemic stroke. This book aims at providing the preclinical scientist with innovative knowledge and tools to investigate novel mechanisms of, and treatments for, ischemic brain damage.

Cardiac catheterization has long been a central diagnostic modality in the evaluation of children, adolescents, and adults with congenital heart disease, and in children with acquired heart disease. Over the past two decades, transcatheter interventions have become equally important in the treatment of pediatric and congenital heart disease. Some transcatheter therapies have become established as the standard of care for congenital cardiovascular anomalies previously managed surgically, others serve to supplement surgery in the integrated management of complex lesions, and still others are in their infancy, as pediatric interventional cardiology continues to advance in step with the broader field of pediatric cardiovascular medicine. Since the previous edition of this book, new technologies and techniques have been introduced to the field of pediatric interventional cardiology, much has been learned about established transcatheter therapies, and there has been a substantial increase in the volume of published data on outcomes of transcatheter procedures in congenital and pediatric heart disease. With increasing experience, the role of interventional catheterization has become solidified as an integral component of the comprehensive management of patients with essentially all forms of congenital heart disease. Cardiac catheterization has also become established as a distinct subspecialty within the discipline of pediatric cardiology, and at many centers has become the purview of cardiologists who have received specialized training in interventional catheterization and whose practice is focused on catheterization. This book is targeted to trainees and established interventional cardiologists alike, and is intended as a comprehensive reference for the clinical practice of diagnostic and interventional cardiology in pediatric and congenital heart disease. In the organization of this book, a combination of procedure-based and problem-based approaches has been employed. The structure of the book has been updated to make it more reader friendly, chapters have been added to address new techniques and problems in the field, and greater emphasis has been placed on evaluation of outcomes of transcatheter interventions in congenital heart disease. Section 1 covers the fundamentals of cardiac catheterization, with chapters devoted to pre-procedure patient evaluation, sedation and anesthesia, vascular access and related issues, catheterization equipment ands its use, hemodynamic evaluation, angiography, radiation and radiation safety, and echocardiography in the catheterization lab. Sections 2 through 4 include procedure-based chapters that are organized according to the technical type of intervention. Section 2 is devoted to transcatheter interventions for obstructive lesions, including valvar stenoses and vascular obstructions. Section 3 includes chapters that cover interventions to close various pathologic intracardiac communications and vascular anomalies. Section 4 includes chapters covering interventions performed to create or enlarge intracardiac communications, as well as other interventions. Section 5 focuses on the applications of catheterization and transcatheter interventions in the evaluation and management of specific patient populations. This problem-based or patient-based focus, which is substantially expanded from the previous edition of the book, reflects the expanding role of catheterization in the comprehensive management of pediatric and congenital heart disease, and addresses emerging applications of transcatheter interventions, including management of the patient receiving extracorporeal circulatory support, hybrid transcatheter-surgical interventions, and prenatal cardiac intervention. Section 6 includes two chapters that cover outcome assessment and regulatory issues pertinent to the pediatric cardiology in general and interventional cardiology in particular.