Cardioprotective Effect of Losartan Alone or in Combination with Remote Ischemic Preconditioning on the Biochemical Changes Induced by Ischemic/Reperfusion Injury in a Mutual Prospective Study with a Clinical and Experimental Animal Arm.
Sudden reperfusion of the ischemic myocardium, initiates a cascade of cellular events that lead to additional cellular damage and death called ischemic reperfusion (I/R) injury. Investigational studies have identified several factors that mediate the harmful effects of I/R injury such as the pH paradox, intracellular and mitochondrial Ca2+ overload, accumulation of reactive oxygen species (ROS) due to massive input of oxygen by reperfusion and down regulation of basal nitric oxide (NO) in the cell.
Percutaneous coronary intervention (PCI) has become the principal coronary revascularization strategy for stable and unstable coronary artery disease (CAD) patients.5-7 However, (I/R) injury post PCI may represent either an acceleration of the pathological processes initiated during ischemia or new pathophysiological changes that develop after reperfusion. The injury can mediate cell death, microvascular damage, myocardial stunning, and potentially lethal arrhythmias which worsen the clinical outcomes after PCI.
Ischemic preconditioning (IPC) concept is now well known10 where the application of brief episodes of ischemia reperfusion before sustained ischemia creates a condition of adaptive responses of cardiac cells to various kinds of stress induced by I/R.6 Further research in the area led to the development of remote ischemic preconditioning (RIPC) technique where the
application of brief cycles of ischemia reperfusion in organs remote from the tissue of sustained ischemia can reduce the I/R injury in that ischemic tissue on reperfusion.
Heart Res Open J. 2017; 4(3): 57-65. doi: 10.17140/HROJ-4-142