Protecting the Heart: Biological Targets and Clinical Strategies

The pathophysiology of myocardial damage in the setting of ischemic cardiomyopathy is complicated by the fact that the process of restoring blood flow to the ischemic cardiomyocytes can itself induce injury to the myocardium. This phenomenon, termed reperfusion injury, reduces the benefits of vessel recanalization and contributes to the damage initiated by occlusion. The interest on techniques aiming at protecting the heart from ischemia-reperfusion (IR) injury has constantly grown over the last two decades. Three main actors of IR injury can be identified: 1) cardiomyocite-related damage, 2) vascular-related injury and 3) inflammatory-related injury. Ideally targeting the series of molecular events that take place during myocardial reperfusion, this area of research focuses on the different strategies that may help to render the heart more resistant to the ischemic insult. The aim of this article is to highlight the clinical relevance of IR injury, how IR-injury can be assessed clinically as well as to review the current strategies, both pharmacological and non pharmacological, that show promise for translation to clinical practice.