New paradigms of coronary artery diseases

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Detailed analyses of regional myocardial blood flow, function, metabolism, and morphology in ischemic and reperfused myocardium have identified key phenomena such as myocardial hibernation, stunning, and ischemic preconditioning. Both hibernating and stunned myocardium represent viable but dysfunctional tissue, distinct from necrotic tissue. The emergence of reperfusion procedures has made it crucial to differentiate between reversibly and irreversibly injured, hypofunctional myocardium. While the pathophysiological distinctions between hibernating and stunned myocardium are debated, reperfusion remains essential. Ischemic preconditioning is recognized as the most effective method to delay infarct development, with its clinical relevance suggested by retrospective analyses of myocardial infarction patients and controlled PTCA studies. However, the potential for pharmacological preconditioning in clinical settings is yet to be determined. The underlying mechanisms and signaling pathways of myocardial hibernation, stunning, and ischemic preconditioning are not fully understood. Recent focused issues on these topics published in Basic Research in Cardiology have garnered significant interest, leading to their compilation into a separate monograph. Gratitude is extended to all contributors, as well as to Ms. Ibkendanz of Steinkopff and Ms. Philipp and Mr. Heinrichs from Bayer AG Germany for their support in this publication.