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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2015; 7(10): 621-632
Published online Oct 26, 2015. doi: 10.4330/wjc.v7.i10.621
Cardioprotection by remote ischemic conditioning: Mechanisms and clinical evidences
Alberto Aimo, Chiara Borrelli, Alberto Giannoni, Luigi Emilio Pastormerlo, Andrea Barison, Gianluca Mirizzi, Michele Emdin, Claudio Passino
Alberto Aimo, Chiara Borrelli, Michele Emdin, Claudio Passino, Institute of Life Sciences, Scuola Superiore Sant’Anna, 56126 Pisa, Italy
Alberto Giannoni, Luigi Emilio Pastormerlo, Andrea Barison, Gianluca Mirizzi, Michele Emdin, Claudio Passino, Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Claudio Passino, MD, Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, via Giuseppe Moruzzi 1, 56124 Pisa, Italy. passino@ftgm.it
Telephone: +39-050-3152191 Fax: +39-050-3152109
Received: May 19, 2015
Peer-review started: May 20, 2015
First decision: June 24, 2015
Revised: July 21, 2015
Accepted: August 13, 2015
Article in press: August 14, 2015
Published online: October 26, 2015
Abstract

In remote ischemic conditioning (RIC), several cycles of ischemia and reperfusion render distant organ and tissues more resistant to the ischemia-reperfusion injury. The intermittent ischemia can be applied before the ischemic insult in the target site (remote ischemic preconditioning), during the ischemic insult (remote ischemic perconditioning) or at the onset of reperfusion (remote ischemic postconditioning). The mechanisms of RIC have not been completely defined yet; however, these mechanisms must be represented by the release of humoral mediators and/or the activation of a neural reflex. RIC has been discovered in the heart, and has been arising great enthusiasm in the cardiovascular field. Its efficacy has been evaluated in many clinical trials, which provided controversial results. Our incomplete comprehension of the mechanisms underlying the RIC could be impairing the design of clinical trials and the interpretation of their results. In the present review we summarize current knowledge about RIC pathophysiology and the data about its cardioprotective efficacy.

Keywords: Remote ischemic conditioning, Ischemic heart disease, Percutaneous coronary intervention, Cardiac surgery, Atherosclerosis

Core tip: Remote ischemic conditioning (RIC) is a safe, non-invasive, and inexpensive technique that has the potential to protect the heart against the ischemia-reperfusion injury. Its cardioprotective efficacy is currently being evaluated, and diverging results are emerging. It is thus worth resuming current understanding of RIC pathophysiology and clinical efficacy.