ABSTRACT
Mild therapeutic hypothermia of 32-35degrees C improved neurologic outcomes in outside hospital cardiac arrest survivor. Furthermore, in experimental studies on infarcted model and pilot studies on conscious patients with acute myocardial infarction, therapeutic hypothermia successfully reduced infarct size and microvascular resistance. Therefore, mild therapeutic hypothermia has received an attention as a promising solution for reduction of infarction size after acute myocardial infarction which are not completely solved despite of optimal reperfusion therapy. Nevertheless, the results from randomized clinical trials failed to prove the cardioprotective effects of therapeutic hypothermia or showed beneficial effects only in limited subgroups. In this article, we reviewed rationale for therapeutic hypothermia and possible mechanisms from previous studies, effective methods for clinical application to the patients with acute myocardial infarction, lessons from current clinical trials and future directions.
Subject(s)
Humans , Male , Middle Aged , Acute Disease , Body Temperature , Hypothermia, Induced/methods , Myocardial Infarction/therapy , Myocardial Reperfusion Injury/prevention & control , Time Factors , Treatment OutcomeABSTRACT
O tratamento da doença cardiovascular mudou radicalmente nas últimas duas décadas, proporcionando aos pacientes uma sobrevida maior e melhor qualidade de vida. Grande parte desse sucesso deve-se à introdução de novas terapias. Em nenhuma outra área essa mudança foi mais evidente do que na cardiologia intervencionista, pois nos últimos vinte anos as intervenções cardiovasculares percutâneas saíram do terreno experimental para formar a base terapêutica dos portadores de doença cardiovascular sintomática. O desenvolvimento dessas tecnologias, desde os primeiros estágios, requer a realização de estudos pré-clínicos com modelos animais. É possível compreender os mecanismos terapêuticos desses dispositivos, uma vez introduzidos na esfera clínica, comparando-se os achados das pesquisas realizadas com modelos animais com amostras de exames anatomopatológicos. Esta análise apresenta uma visão geral do papel emergente dos estudos pré-clínicos, bem como dos resultados, do desenvolvimento e da avaliação de modelos amimais, nas tecnologias de intervenção cardiovascular percutânea para tratamento de pacientes com doença cardiovascular sintomática.
The treatment of cardiovascular disease has changed dramatically over the past 2 decades, allowing patients to live longer and better quality lives. The introduction of new therapies has contributed much to this success. Nowhere has this been more evident than in interventional cardiology, where percutaneous cardiovascular intervention has evolved in the past 2 decades from a quirky experimental procedure to a therapeutic cornerstone for patients with symptomatic cardiovascular disease. The development of these technologies from the earliest stages requires preclinical experiments using animal models. Once introduced into the clinical arena, an understanding of therapeutic mechanisms of these devices can be ascertained through comparisons of animal model research findings with clinical pathological specimens. This review provides an overview of the emerging role, results of preclinical studies and development, and evaluation of animal models for percutaneous cardiovascular intervention technologies for patients with symptomatic cardiovascular disease.