Způsobuje reperfuze poškození myokardu?

Cor Vasa 2002, 43(10):415-421

Does reperfusion cause myocardial injury?

Petr Ošťádal^1,*, David Alan¹, Jiří Vejvoda¹, Bohuslav Ošťádal²: ¹ Interní klinika, Fakultní nemocnice Motol a 2. lékařská fakulta Univerzity Karlovy; ² Fyziologický ústav Akademie věd České republiky a Centrum experimentálního výzkumu chorob srdce a cév, Praha, Česká republika

Enormous effort has been made in cardiovascular research over the past three decades to explain the pathogenic mechanisms occurring during the period of reperfusion of a previously ischemic heart. Although reperfusion is the most efficient treatment strategy for acute myocardial infarction, experimental studies have shown a potentially harmful aspect of reperfusion, i. e., a phenomenon called the "reperfusion injury". It is based on the observation that different types of myocardial injury may occur during reperfusion. There is, however, not enough evidence to demonstrate this injury is caused by reperfusion. Furthermore, clear evidence that reperfusion induces further damage to cardiomyocytes injured already by ischemia is also still lacking. In addition, it has been not demonstrated yet that pharmacologic modification of reperfusion conditions improves the outcome in the long-term run, i. e., that "reperfusion injury" was not responsible for long-term damage. We, therefore, suggest: (i) to use the term "ischemia-reperfusion injury" rather than "reperfusion injury", (ii) a critical approach to clinical observations dealing with the modifications of reperfusion until long-term data become available.