Medical and cellular implications of stunning, hibernation, and preconditioning: an NHLBI workshop

RA Kloner, R Bolli, E Marban, L Reinlib, E Braunwald - Circulation, 1998 - Am Heart Assoc
RA Kloner, R Bolli, E Marban, L Reinlib, E Braunwald
Circulation, 1998Am Heart Assoc
On July 2–3, 1996, the National Heart, Lung, and Blood Institute sponsored a workshop in
Columbia, Md, entitled “The Medical and Cellular Implications of Myocardial Stunning,
Hibernation, and Preconditioning.” The goals of this workshop were to identify and discuss
the areas of agreement and controversy regarding these important phenomena and in
particular to identify areas of future research for each. One aspect of these goals included
determination of the mechanisms of these phenomena. Stunning is a form of prolonged …
On July 2–3, 1996, the National Heart, Lung, and Blood Institute sponsored a workshop in Columbia, Md, entitled “The Medical and Cellular Implications of Myocardial Stunning, Hibernation, and Preconditioning.” The goals of this workshop were to identify and discuss the areas of agreement and controversy regarding these important phenomena and in particular to identify areas of future research for each. One aspect of these goals included determination of the mechanisms of these phenomena. Stunning is a form of prolonged contractile dysfunction that occurs after relief of a discrete episode or episodes of ischemia; hibernation is a form of prolonged contractile dysfunction associated with ongoing low blood flow, although controversy exists as to whether absolute blood flow or coronary reserve is reduced and whether it may represent repetitive bouts of stunning. Preconditioning is a cardioprotective mechanism in which the heart is exposed to a controlled, short period of sublethal ischemia that attenuates cellular damage from a subsequent prolonged lethal episode of ischemia. Research efforts have not yet provided a clear understanding of all aspects of these conditions. The workshop presented the current state of both basic science knowledge and clinical knowledge of these disorders, promoted discussions between basic and clinical scientists, and identified likely mechanisms and new directions for research.
The meeting was chaired by Eugene Braunwald and cochaired by Roberto Bolli, Eduardo Marban, and Robert A. Kloner and was coordinated by Leslie Reinlib. Twenty participants represented a broad spectrum of expertise: basic and clinical scientists, pathologists, and surgeons.(A list of conference participants is provided in the Appendix.) The purpose of this article is to review some of the points made at the workshop in regard to areas of general agreement and controversy and, most importantly, to summarize the areas that need further research. The following discussions briefly review the concepts of stunning, hibernating, and preconditioning discussed at the workshop and some additional material that has become available since the workshop.
Am Heart Assoc