Reperfusion injury risk factors: Difference between revisions
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==Overview== | ==Overview== | ||
Ischemia reperfusion injury is a complex disorder associated with various cardiovascular and other risk factors mainly including Hypertension, hyperlipidemia, Diabetes, Insulin resistance, aging, and defects with coronary artery circulation. Although the exact mechanism about how these causes injury are still not clear but studies done so far best explains their role in mediating oxidative stress and endothelial cell dysfunction, which are the two most important pathophysiological involve in the mediation of injury. | |||
Granger DN. Ischemia-reperfusion: mechanisms of microvascular dysfunction and the influence of risk factors for cardiovascular disease. '''Microcirculation'''''.'' 1999; ''6'': 167–178. | |||
==Risk Factors== | ==Risk Factors== | ||
Risk factors for reperfusion injury | Risk factors for reperfusion injury includes | ||
* [[Hypertension]] with [[left ventricular hypertrophy]], | * [[Hypertension]] with [[left ventricular hypertrophy]], | ||
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It is important to identify the risk factors associated with worse [[reperfusion injury]] in [[STEMI]] patients. This may help in early risk stratification and develop therapeutic targets to reduce the infarct size associated with [[reperfusion injury]]. These risk factors also increase the risk of a first cardiac event and emphasize the importance of secondary prevention. Most of these associations are based on animal studies and includes: | It is important to identify the risk factors associated with worse [[reperfusion injury]] in [[STEMI]] patients. This may help in early risk stratification and develop therapeutic targets to reduce the infarct size associated with [[reperfusion injury]]. These risk factors also increase the risk of a first cardiac event and emphasize the importance of secondary prevention. Most of these associations are based on animal studies and includes: | ||
* [[Left Ventricular hypertrophy]]: Long-standing hypertension leads to pressure overload [[hypertrophy]]. This is associated with metabolic and biochemical changes, predisposing the [[myocardium]] to severe [[reperfusion injury]]. Moreover, increase in [[lactate dehydrogenase]] and [[creatine kinase]] release after reperfusion increases the susceptibility of the hypertrophied heart to [[Ischemia|ischemia/reperfusion injury]]. | * [[Left Ventricular hypertrophy]]: | ||
**Long-standing hypertension leads to pressure overload [[hypertrophy]]. This is associated with metabolic and biochemical changes, predisposing the [[myocardium]] to severe [[reperfusion injury]]. | |||
**Moreover, increase in [[lactate dehydrogenase]] and [[creatine kinase]] release after reperfusion increases the susceptibility of the hypertrophied heart to [[Ischemia|ischemia/reperfusion injury]]. | |||
* [[Heart failure]]: Left ventricular dysfunction may predispose the heart to [[reperfusion injury]]. | * [[Heart failure]]: Left ventricular dysfunction may predispose the heart to [[reperfusion injury]]. | ||
* [[Age]]: Aging is associated with [[ | * [[Age]]: Aging is associated with | ||
* [[Diabetes]]: The data from preclinical studies in diabetic patients is not clear, however, there is clearly increased susceptibility of the heart to ischemic stress and possibly [[reperfusion]]. | **[[Oxidative stress]] as well as | ||
* [[Hyperlipidemia]]: [[Hyperlipidemia]] is a known risk factor for [[ischemic heart disease]]. Animal and human studies have shown that the presence of [[hyperlipidemia]] increase the risk of [[reperfusion injury]] and may also attenuate the protective effect of [[ischemic]] preconditioning. | **Impaired [[systolic]] and [[diastolic]] function,Both the mech. increases the risk related to [[reperfusion injury]]. | ||
*[[Diabetes]]: The data from preclinical studies in diabetic patients is not clear, however, there is clearly increased susceptibility of the heart to ischemic stress and possibly [[reperfusion]]. | |||
*[[Hyperlipidemia]]: [[Hyperlipidemia]] is a known risk factor for [[ischemic heart disease]]. | |||
**Animal and human studies have shown that the presence of [[hyperlipidemia]] increase the risk of [[reperfusion injury]] and may also attenuate the protective effect of [[ischemic]] preconditioning. | |||
==References== | ==References== | ||
Revision as of 18:23, 21 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anjan K. Chakrabarti, M.D. [2]Shivam Singla, M.D.[3] Kashish Goel, M.D.
Overview
Ischemia reperfusion injury is a complex disorder associated with various cardiovascular and other risk factors mainly including Hypertension, hyperlipidemia, Diabetes, Insulin resistance, aging, and defects with coronary artery circulation. Although the exact mechanism about how these causes injury are still not clear but studies done so far best explains their role in mediating oxidative stress and endothelial cell dysfunction, which are the two most important pathophysiological involve in the mediation of injury.
Granger DN. Ischemia-reperfusion: mechanisms of microvascular dysfunction and the influence of risk factors for cardiovascular disease. Microcirculation. 1999; 6: 167–178.
Risk Factors
Risk factors for reperfusion injury includes
- Hypertension with left ventricular hypertrophy,
- Congestive heart failure
- Increased age,
- Diabetes, and
- Hyperlipidemia
It is important to identify the risk factors associated with worse reperfusion injury in STEMI patients. This may help in early risk stratification and develop therapeutic targets to reduce the infarct size associated with reperfusion injury. These risk factors also increase the risk of a first cardiac event and emphasize the importance of secondary prevention. Most of these associations are based on animal studies and includes:
- Left Ventricular hypertrophy:
- Long-standing hypertension leads to pressure overload hypertrophy. This is associated with metabolic and biochemical changes, predisposing the myocardium to severe reperfusion injury.
- Moreover, increase in lactate dehydrogenase and creatine kinase release after reperfusion increases the susceptibility of the hypertrophied heart to ischemia/reperfusion injury.
- Heart failure: Left ventricular dysfunction may predispose the heart to reperfusion injury.
- Age: Aging is associated with
- Oxidative stress as well as
- Impaired systolic and diastolic function,Both the mech. increases the risk related to reperfusion injury.
- Diabetes: The data from preclinical studies in diabetic patients is not clear, however, there is clearly increased susceptibility of the heart to ischemic stress and possibly reperfusion.
- Hyperlipidemia: Hyperlipidemia is a known risk factor for ischemic heart disease.
- Animal and human studies have shown that the presence of hyperlipidemia increase the risk of reperfusion injury and may also attenuate the protective effect of ischemic preconditioning.