Conditioning of the heart: from pharmacological interventions to local and remote protection: possible implications for clinical practice.

Ischemic preconditioning is a natural protective mechanism by which brief episodes of ischemia protect the heart or other organs from the deleterious effects of ischemia-reperfusion injury. Ischemic preconditioning was demonstrated in animals more than 20 years ago, and subsequent studies in humans showed a dramatic protective effect on the heart. This method did not translate into clinical practice partially due to difficulty in application of conditioning. At the same time, multiple drugs were assessed, but none proved to be beneficial in large scale studies for myocardial protection. Although multicenter studies are still lacking, it was recently demonstrated in reasonable sized studies that in patients undergoing percutaneous coronary interventions or suffering from myocardial infarction, remote ischemic conditioning has beneficial protective effect. With more studies we may see translation into clinical practice in the near future.