It has been almost 15 years since the fIrst reports appeared indicating that adenosine exerted a .protective effect in ischemic and reperfused myocardium. Numerous experimental studies have shown that adenosine (both exogenous and endogenous adenosine) delays the onset of ischemic contracture, modulates myocardial metabolism during ischemia, attenuates reversible postischemic ventricular dysfunction (myocardial stunning), and reduces myocardial infarct size. Initial studies on adenosine's cardioprotective effect were based on its ability to stimulate postischemic ATP resynthesis, increase coronary blood flow, and reduce heart rate. Although these actions of adenosine are undoubtedly benefIcial to the ischemic/reperfused heart, it now appears that adenosine's cardioprotective effect may be exclusive of these properties. The immense growth in the number of articles on adenosine cardioprotection in the last several years has been related in large part to the hypothesis that adenosine plays a role in ischemic preconditioning. Ischemic preconditioning is the phenomenon in which a brief period of ischemia (and reperfusion) prior to a more prolonged occlusion reduces myocardial infarct size. This form of myocardial protection has received much interest because ischemic preconditioning has been shown to be the most potent means of reducing infarct size in all animal models thus far tested. In fact prior to studies implicating adenosine's role in ischemic preconditioning, adenosine's infarct reducing effect was not well recognized.

Zusammenfassung
The immense growth in the number of articles on adenosine cardioprotection has been related in large part to the hypothesis that adenosine plays a role in ischemic preconditioning. This title discusses different aspects of adenosine cardioprotection and ischemic preconditioning, including potential mechanisms and clinical applications.

Inhalt
I. Adenosine and Cardioprotection.- 1. Adenosine and Cardioprotection.- II. Cardioprotection and Mechanisms of Ischemic and Reperpusion Injury.- 2. Concept of Cardioprotection Against Myocardial Ischemia.- 3. The Late Phase of Preconditioning Against Myocardial Stunning.- 4. Coronary Perfusion as the Major Determinant of Myocardial Contractility in the Heart: Implication for Myocardial Hibernation.- 5. Myocardial Protection From Reperfusion Injury With Adenosine.- III. Cellular Mechanisms of Cardioprotection in Ischemic Preconditioning.- 6. Protein Kinase C - the Key-Enzyme in Ischémic Preconditioning?.- 7. Adenosine, Cardioprotection and Potential Mechanisms.- 8. Activation of Ecto-5'-nucleotidase Mediates Cardioprotection in Ischemic Preconditioning: Important Role of Protein Kinase C.- 9. Role of Mn-SOD Induction in the Second Window Phenomenon of Preconditioning of Ischemic Hearts.- 10. Opioid Receptors, KATP Channels and Ischemic Preconditioning.- 11. Bradykinin and Preconditioning Against Infarction.- 12. Preconditioning in Human Muscle and Myocytes.- 13. Protein Kinase C and Adenosine Synergistically Activate ATP-Sensitive Potassium Currents: Implications for Ischemic Preconditioning.- Clinical Application of New Strategies to Protect The Ischemic Heart.- 14. Adenosine and Myocardial Protection in Humans.- 15. Clinical Applications of Ischemic Preconditioning.- 16. Clinical Pharmacology of Preconditioning and Adenosinergic Drugs.- 17. Clinical Application of Ischemic Preconditioning by ATP-Sensitive Potassium Channel Openers.- 18. Potassium Channel Openers and Cardiac Surgery.- 19. Anti-ischemic Effects of the ATP-sensitive Potassium Channel Opener During Coronary Angioplasty.- 20. Clinical Impact of Ischemic Preconditioning on Infarct Size and CoronaryNo-reflow Phenomenon after Successful Recanalization in the Acute Myocardial Infarction.