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Ann Thorac Surg 2003;76:105-111
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Ischemic preconditioning is not cardioprotective in senescent human myocardium

^a Cardiothoracic Surgery, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany

Accepted for publication January 18, 2003.

^* Address reprint requests to Dr Simm, Klinik fuer Herz- und Thoraxchirurgie, Martin-Luther-Universitaet Halle-Wittenberg, Ernst-Grube-Str 40, D-06120 Halle, Saale, Germany.
e-mail: andreas.simm{at}medizin.uni-halle.de

BACKGROUND: Cellular and functional changes secondary to aging could impair myocardial tolerance to ischemia and affect the heart’s response to ischemic preconditioning.

METHODS: We investigated the impact of cardiac aging on preconditioning in right atrial trabeculae of adult patients ( 55 years) and senescent patients ( 70 years) with coronary artery disease. Specimens were subjected to 30 minutes of simulated ischemia (hypoxic substrate-free superfusion) with and without 5 minutes of ischemic pretreatment. Postischemic contractile recovery was measured and expressed as percentage of base line force values.

RESULTS: During the reoxygenation period, trabeculae of adult patients but not those of senescent patients improved after ischemic preconditioning. After 40 minutes of reoxygenation, preconditioned adult trabeculae developed 57% ± 5% of their preischemic force (nonpreconditioned control 44% ± 5%, p < 0.01), senescent trabeculae recovered to 44% ± 4% (control 45% ± 3%). Especially myocardium from adult patients with Canadian Cardiovascular Society (CCS) stage III angina pectoris treated with ACE inhibitors recovered well (70% ± 7%; control 50% ± 8%, p < 0.01), contrasting with trabeculae from patients with CCS stage II angina (44% ± 5%; control 40% ± 10%). Ischemia-inducible Hsp70 (human heat shock protein) was additionally measured after reoxygenation. Total Hsp70 mRNA was elevated in preconditioned myocardium along with its contractile recovery (r = 0.33, p = 0.07). Because the control transcription, analyzing 18S rRNA and ß-actin, was reduced by ischemia but recovered in preconditioned trabeculae, relative Hsp70 mRNA was not altered.

CONCLUSIONS: Our data indicate that ischemic preconditioning has no beneficial effect on the postischemic functional recovery of senescent human myocardium.

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