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It has been almost 15 years since the fIrst reports appeared
indicating that adenosine exerted a .protective effect in ischemic
and reperfused myocardium. Numerous experimental studies have shown
that adenosine (both exogenous and endogenous adenosine) delays the
onset of ischemic contracture, modulates myocardial metabolism
during ischemia, attenuates reversible postischemic ventricular
dysfunction (myocardial stunning), and reduces myocardial infarct
size. Initial studies on adenosine's cardioprotective effect were
based on its ability to stimulate postischemic ATP resynthesis,
increase coronary blood flow, and reduce heart rate. Although these
actions of adenosine are undoubtedly benefIcial to the
ischemic/reperfused heart, it now appears that adenosine's
cardioprotective effect may be exclusive of these properties. The
immense growth in the number of articles on adenosine
cardioprotection in the last several years has been related in
large part to the hypothesis that adenosine plays a role in
ischemic preconditioning. Ischemic preconditioning is the
phenomenon in which a brief period of ischemia (and reperfusion)
prior to a more prolonged occlusion reduces myocardial infarct
size. This form of myocardial protection has received much interest
because ischemic preconditioning has been shown to be the most
potent means of reducing infarct size in all animal models thus far
tested. In fact prior to studies implicating adenosine's role in
ischemic preconditioning, adenosine's infarct reducing effect was
not well recognized.
The immense growth in the number of articles on adenosine
cardioprotection in recent years has been related in large part to
the hypothesis that adenosine plays a role in ischemic
preconditioning. Ischemic preconditioning is the phenomenon in
which a brief period of ischemia (and reperfusion) prior to a more
prolonged occlusion reduces myocardial infarct size. This form of
myocardial protection has received much interest because ischemic
preconditioning has been shown to be the most potent means of
reducing infarct size in all animal models so far tested. Within
the last six years, the principal focus of adenosine
cardioprotection research has centered on the role of adenosine
receptors. It is currently thought that adenosine protects the
ischemic heart primarily via the activation of adenosine A1
receptors located on the cardiac myocytes. Adenosine is used
clinically for terminating supraventricular tachycardia, and as a
diagnostic tool in coronary imaging, and has been used
postoperatively for blood pressure control after heart
surgery.There are also recent reports that adenosine may be safely
tolerated and a potentially beneficial additive to cardioplegic
solutions during open heart surgery in humans. There is even
evidence that ischemic preconditioning may occur in humans under
various clinical situations. This volume contains chapters from
contributors to the first three symposia on 'Adenosine,
Cardioprotection, and its Clinical Application'. All aspects of
adenosine cardioprotection and ischemic preconditioning, including
potential mechanisms and clinical applications, are discussed by
experts in these areas. The reader will find this book to be an
excellent source of information on these topics, as well as a guide
to future experiments.
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