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(Circulation. 1998;97:1848-1867.)
© 1998 American Heart Association, Inc.

Special Reports

Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning

An NHLBI Workshop

Robert A. Kloner, MD, PhD; Roberto Bolli, MD; Eduardo Marban, MD, PhD; Leslie Reinlib, PhD; ; Eugene Braunwald, MD

From the Heart Institute, Good Samaritan Hospital, and University of Southern California, Los Angeles (R.A.K.); University of Louisville (R.B.), Louisville, Ky; Johns Hopkins University (E.M.), Baltimore, Md; Harvard Medical School, Brigham and Women's Hospital (E.B.), Boston, Mass; and the National Heart, Lung, and Blood Institute (L.R.), Bethesda, Md.

Key Words: stunning, myocardial • hibernation • preconditioning • ischemia • infarction

	Introduction

 
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 . . . [Full Text of this Article]

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				K. Imahashi, T. Nishimura, J. Yoshioka, and H. Kusuoka Role of Intracellular Na+ Kinetics in Preconditioned Rat Heart Circ. Res., June 8, 2001; 88(11): 1176 - 1182. [Abstract] [Full Text] [PDF]

				J. Muller-Ehmsen, K. L. Peterson, L. Kedes, P. Whittaker, J. S. Dow, T. I. Long, P. W. Laird, and R. A. Kloner Rebuilding a Damaged Heart: Long-Term Survival of Transplanted Neonatal Rat Cardiomyocytes After Myocardial Infarction and Effect on Cardiac Function Circulation, April 9, 2002; 105(14): 1720 - 1726. [Abstract] [Full Text] [PDF]