Pathophysiologie des myokardialen Reperfusionsschadens

Zusammenfassung

In der Kardiologie ist das schnelle interventionelle Wiedereröffnen akut verschlossener Koronargefäße heute die wirksamste Therapie, um einen drohenden Herzinfarkt einzugrenzen. Die Frühphase der Reperfusion ist als therapeutisches Fenster aber klinisch noch weitgehend ungenutzt. Experimentell ist klar belegt, dass die Modalitäten der Reperfusion einen wesentlichen Einfluss auf die Infarktgröße haben, da Reperfusion selbst auch Gewebsschädigung herbeiführen kann (Reperfusionsschaden). Wichtigster Auslöser für den durch Reperfusion akut ausgelösten Zellschaden ist die Hyperkontraktur der Herzmuskelzellen. Zytosolische Ca²⁺-Überladung und Fehlfunktionen der Zellorganellen sarkoplasmatisches Retikulum und Mitochondrien bestimmen die Pathophysiologie des Reperfusionsschadens. Diese Mechanismen können in den ersten Minuten der Reperfusion durch Aktivierung protektiver zellulärer Signalwege beeinflusst werden (Reperfusionstherapie). Erste klinische Studien belegen die Wirksamkeit einer akuten Reperfusionstherapie.

Summary

Rapid interventional restoration of coronary blood flow is the most effective therapy to limit infarct size in todayŽs cardiology. The early phase of reperfusion represents, however, a window of therapeutic opportunities largely unused in the clinic. Experimentally it has been clearly shown that the modalities of reperfusion have a substantial impact on infarct size, since reperfusion itself can damage the myocardium (reperfusion injury). The major cause for acute injury of the cardiomyocytes in reperfusion is their hypercontracture. Cytosolic Ca²⁺ overload and malfunction of cell organelles, i. e. sarcoplasmic reticulum and mitochondria, determine the pathophysiology of reperfusion injury. The underlying mechanisms can be influenced in the first minutes of reperfusion by activation of protective signalling pathways (reperfusion therapy). First clinical studies confirm the efficacy of acute reperfusion therapy.

Schlüsselwörter

Myokardinfarkt - Reperfusionsschaden - Myokardprotektion - Mitochondrien - Calcium

Key words

myocardial infarction - reperfusion injury - myocardial protection - mitochondria - calcium

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