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Remote ischaemic conditioning before exercise: are we there yet?
  1. Ronit Lavi1,
  2. Shahar Lavi2
  1. 1Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
  2. 2Department of Medicine, Division of Cardiology, London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada
  1. Correspondence to Shahar Lavi, Division of Cardiology, The University of Western Ontario, 339 Winderemere Road, P O Box 5339, London, Ontario N6A 5A5, Canada; shahar.lavi{at}lhsc.on.ca

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In recent years we have witnessed substantial progress in the treatment of patients with ischaemic heart disease. Interventional techniques are improving and medical therapy is more effective. In particular, there has been dramatic progress in the treatment of patients with ST elevation myocardial infarction. These patients are being treated effectively by primary percutaneous coronary interventions, restoring flow to the ischaemic heart tissue, together with intensive medical treatment. However, in spite of this progress, ischaemia-reperfusion injury and its consequences remain a significant issue. Agents that were thought to be cardioprotective, including antioxidants and anti-inflammatory agents as well as adenosine, have not proved to be effective.1 There are some encouraging results from small studies,2 but so far none of the large trials has shown a beneficial effect of any medication in reducing ischaemia-reperfusion injury. In contrast, the results of studies involving ischaemic conditioning have shown a more powerful effect than individual medications that target only one pathway.

Ischaemic conditioning is an innate protective phenomenon by which brief episodes of ischaemia protect the organs from prolonged and potentially lethal ischaemia. Ischaemic conditioning was found to be effective in different organs, but its potential to protect the heart is probably …

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