Cardiovagal activity confers cardioprotection after myocardial infarction: Recent advances

Abstract

It has been known for many years that normal functioning of the cardiovascular system depends on an adequate sympathetic–parasympathetic interaction. Also, it is known that a decreased parasympathetic tone is detrimental for the myocardium and is associated with a worse prognosis of cardiovascular diseases, particularly heart failure secondary to a myocardial infarction. Ischaemic preconditioning is among a number of myocardial protection strategies in ischaemic heart disease that have been developed in recent years. In this physiopathological entity described in 1996, brief episodes of ischaemia protect the myocardium from subsequent prolonged ischaemia. However, cardiologists do not have easy access to the heart to perform short preconditioning ischaemia; therefore, this form of preconditioning is difficult for clinical application. Thus, cardiovascular researchers looked for another method of myocardial protection. A variant is remote ischaemic preconditioning (RIPC), in which the preconditioning stimulus is delivered in an organ or tissue away from the heart. Somehow, these short periods of ischaemia at a site distant from the target organ protect the heart in the same way that local ischaemic preconditioning does. Although this new method of distant heart protection has attracted considerable interest among researchers, which is reflected in the numerous papers published in recent years, the mechanisms involved are not yet known in detail.