Editor—We thank Drs Kumar and Kumar for their interest in our paper. Over the past 30 years, hundreds of experimental interventions (pharmacological and non-pharmacological) have been reported to protect the ischaemic myocardium in experimental animals. However, with the exception of early reperfusion, none has been translated into clinical practice. The National Heart, Lung, and Blood Institute convened a working group to discuss the reasons for the failure to translate potential therapies for protecting the heart from ischaemia and reperfusion and to recommend new approaches to accomplish this goal. The Working Group concluded that cardioprotection in the setting of acute myocardial infarction, cardiac surgery and cardiac arrest is at a crossroad. The Working Group urged a new focus on translational research that emphasizes efficacy and clinically relevant outcomes, and recommended the establishment of a system for rigorous preclinical testing of promising cardioprotective agents with clinical trial-like approaches (i.e. blinded, randomized, multicentre and adequately powered studies using standardized methods). Our pilot study was designed to provide preliminary data to test the hypothesis that levosimendan has a preconditioning effect in patients. A power analysis performed on the basis of the study suggests that a sample size requirement of 96 patients (48 in each group) would be needed to detect a reduction in median ICU length of stay from 35 h in the control group to 24 h in the protocol group (a=0.05, power 0.9). This further trial is currently underway in our hospital.
Rome, Italy
E-mail: vincenzo.desantis{at}uniroma1.it
Footnotes
This letter was originally submitted as an E-letter.
References
1 Tritapepe L, De Santis V, Vitale D, et al. Preconditioning effects of levosimendan in coronary artery bypass grafting—a pilot study. Br J Anaesth 2006; 96:694–700
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