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Godo S, Takahashi J, Shiroto T, Yasuda S, Shimokawa H. Coronary Microvascular Spasm: Clinical Presentation and Diagnosis. Eur Cardiol 2023; 18:e07. [PMID: 37377449 PMCID: PMC10291603 DOI: 10.15420/ecr.2022.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/13/2022] [Indexed: 06/29/2023] Open
Abstract
Professor Maseri pioneered the research and treatment of coronary vasomotion abnormalities represented by coronary vasospasm and coronary microvascular dysfunction (CMD). These mechanisms can cause myocardial ischaemia even in the absence of obstructive coronary artery disease, and have been appreciated as an important aetiology and therapeutic target with major clinical implications in patients with ischaemia with non-obstructive coronary artery disease (INOCA). Coronary microvascular spasm is one of the key mechanisms responsible for myocardial ischaemia in patients with INOCA. Comprehensive assessment of coronary vasomotor reactivity by invasive functional coronary angiography or interventional diagnostic procedure is recommended to identify the underlying mechanisms of myocardial ischaemia and to tailor the best treatment and management based on the endotype of INOCA. This review highlights the pioneering works of Professor Maseri and contemporary research on coronary vasospasm and CMD with reference to endothelial dysfunction, Rho-kinase activation and inflammation.
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Affiliation(s)
- Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of MedicineSendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of MedicineSendai, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of MedicineSendai, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of MedicineSendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of MedicineSendai, Japan
- Graduate School, International University of Health and WelfareNarita, Japan
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Pahimi N, Rasool AHG, Sanip Z, Bokti NA, Yusof Z, W. Isa WYH. An Evaluation of the Role of Oxidative Stress in Non-Obstructive Coronary Artery Disease. J Cardiovasc Dev Dis 2022; 9:jcdd9020051. [PMID: 35200704 PMCID: PMC8878238 DOI: 10.3390/jcdd9020051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Approximately half of all women presenting to the emergency department with angina chest pain do not have obstructive coronary artery disease (CAD) on coronary angiography. This condition is termed non-obstructive coronary artery disease (NOCAD), and includes ischemia with no obstructive coronary artery disease (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Oxidative stress has been reported to be involved in the development and progression of CAD. However, a scarcity of studies has assessed a correlation between oxidative stress and NOCAD. Thus, a literature review was performed of available reports on the role of oxidative stress in NOCAD. Possible mechanisms involved in oxidative stress that may contribute to NOCAD were identified and evaluated. A key finding of this literature review was that oxidative stress caused vasoconstriction and endothelial damage, and this results in coronary microvascular dysfunction and vasospasm, which, in turn, lead to the pathogenesis of NOCAD.
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Affiliation(s)
- Nurnajwa Pahimi
- Pharmacology Vascular Laboratory, Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia; (N.P.); (A.H.G.R.)
- Cardiology Unit, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (N.A.B.); (Z.Y.)
| | - Aida Hanum Ghulam Rasool
- Pharmacology Vascular Laboratory, Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia; (N.P.); (A.H.G.R.)
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Zulkefli Sanip
- Central Research Laboratory, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
| | - Nur Adilah Bokti
- Cardiology Unit, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (N.A.B.); (Z.Y.)
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Zurkurnai Yusof
- Cardiology Unit, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (N.A.B.); (Z.Y.)
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - W. Yus Haniff W. Isa
- Cardiology Unit, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia; (N.A.B.); (Z.Y.)
- Department of Internal Medicine, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Correspondence: ; Tel.: +60-9767-3987
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3
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Late gadolinium enhancement on cardiac magnetic resonance imaging is associated with coronary endothelial dysfunction in patients with dilated cardiomyopathy. Heart Vessels 2017; 33:393-402. [DOI: 10.1007/s00380-017-1069-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
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van Mil ACCM, Pearson J, Drane AL, Cockcroft JR, McDonnell BJ, Stöhr EJ. Interaction between left ventricular twist mechanics and arterial haemodynamics during localised, non-metabolic hyperaemia with and without blood flow restriction. Exp Physiol 2016; 101:509-20. [DOI: 10.1113/ep085623] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Affiliation(s)
| | - James Pearson
- Cardiff Metropolitan University; Cardiff UK
- University of Colorado; Colorado Springs CO USA
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Uemura T, Yamamuro M, Kaikita K, Takashio S, Utsunomiya D, Hirakawa K, Nakayama M, Sakamoto K, Yamamoto E, Tsujita K, Kojima S, Hokimoto S, Yamashita Y, Ogawa H. Late gadolinium enhancement on cardiac magnetic resonance predicts coronary vasomotor abnormality and myocardial lactate production in patients with chronic heart failure. Heart Vessels 2016; 31:1969-1979. [PMID: 26892530 PMCID: PMC5122619 DOI: 10.1007/s00380-016-0816-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/05/2016] [Indexed: 12/15/2022]
Abstract
Myocardial fibrosis and microvascular dysfunction are key determinants of outcome in heart failure (HF); we examined their relationship in patients with HF. Our study included 61 consecutive patients with HF but without coronary stenosis. All underwent gadolinium-enhanced cardiac magnetic resonance to evaluate late gadolinium enhancement (LGE) and an acetylcholine (ACh) provocation test to evaluate microvascular dysfunction. During the ACh provocation test, we sampled blood simultaneously from the coronary sinus and aortic root to compare lactate concentrations. We quantified coronary blood flow volume using an intracoronary Doppler-tipped guidewire. We detected LGE in 34 patients (LGE-positive); 27 were LGE-negative. Coronary blood flow volume increased significantly after the ACh provocation test only in LGE-negative patients (before vs. after ACh, 47.5 ± 36.8 vs. 69.2 ± 48.0 ml/min, respectively; p = 0.004). The myocardial lactate extraction ratio (LER) significantly decreased after the ACh test in both groups (LGE-negative, p = 0.001; LGE-positive, p < 0.001), significantly more so in the LGE-positive group (p = 0.017). Multivariate logistic regression analysis showed that a post-ACh LER < 0 (indicating myocardial lactate production) was a significant predictor of LGE-positivity (odds ratio 4.54; 95 % confidence interval 1.38-14.93; p = 0.013). In the LGE-positive group, an LGE volume greater than the median significantly predicted a post-ACh LER of <0 (p = 0.042; odds ratio 6.02; 95 % confidence interval 1.07-33.86). ACh-provoked coronary vasomotor abnormality is closely correlated with myocardial fibrosis in patients with HF but without organic coronary stenosis. Coronary vasomotor abnormalities in fibrotic myocardium may worsen HF.
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Affiliation(s)
- Tomoaki Uemura
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Megumi Yamamuro
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Koichi Kaikita
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Daisuke Utsunomiya
- Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kyoko Hirakawa
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Mina Nakayama
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kenji Sakamoto
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Eiichiro Yamamoto
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kenichi Tsujita
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Sunao Kojima
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Seiji Hokimoto
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yasuyuki Yamashita
- Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisao Ogawa
- Departments of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.,Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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Yamanaga K, Tsujita K, Komura N, Kaikita K, Sakamoto K, Miyazaki T, Saito M, Ishii M, Tabata N, Akasaka T, Sato K, Horio E, Arima Y, Kojima S, Tayama S, Nakamura S, Hokimoto S, Ogawa H. Single-wire pressure and flow velocity measurement for quantifying microvascular dysfunction in patients with coronary vasospastic angina. Am J Physiol Heart Circ Physiol 2015; 308:H478-84. [DOI: 10.1152/ajpheart.00593.2014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endothelial and vascular smooth muscle dysfunction of epicardial coronary arteries play a pivotal role in the pathogenesis of vasospastic angina (VSA). However, coronary microvascular (MV) function in patients with VSA is not fully understood. In the present study, subjects without coronary obstruction were divided into two groups according to the acetylcholine provocation test: VSA group ( n = 29) and non-VSA group ( n = 21). Hyperemic MV resistance (hMR) was measured using a dual-sensor (Doppler velocity and pressure)-equipped guidewire, and guidewire-derived hemodynamic parameters were compared. There were no between-group differences in clinical demographics, including potential factors affecting MV function (e.g., diabetes). Although coronary flow velocity reserve was similar between the two groups [2.4 ± 1.0 (VSA group) vs. 2.4 ± 0.9 (non-VSA group); P = 0.8], coronary vessel resistance and hMR were significantly elevated in the VSA group compared with the non-VSA group (2.6 ± 3.1 vs. 1.2 ± 0.8, P = 0.04; 1.9 ± 0.6 vs. 1.6 ± 0.5, P = 0.03, respectively). Coronary vasospasm, older age, E/e', and estimated glomerular filtration rate were significantly associated with MV dysfunction [defined as ≥ median value of hMR (1.6)] in univariate analysis. Coronary vasospasm most strongly predicted higher hMR in multivariate logistic regression analysis (odds ratio, 4.61; 95% confidence interval, 0.98–21.60; P = 0.053). In conclusion, coronary MV resistance is impaired in patients with VSA compared with non-VSA patients, whereas coronary flow velocity reserve is maintained at normal levels in both groups. In vivo assessment of hMR might be a promising index of coronary MV dysfunction in patients with VSA.
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Affiliation(s)
- Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Naohiro Komura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Takashi Miyazaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Michiyo Saito
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Tomonori Akasaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Koji Sato
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Eiji Horio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Sunao Kojima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Shinji Tayama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
- Division of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; and
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Seyfried TN, Flores RE, Poff AM, D'Agostino DP. Cancer as a metabolic disease: implications for novel therapeutics. Carcinogenesis 2013; 35:515-27. [PMID: 24343361 PMCID: PMC3941741 DOI: 10.1093/carcin/bgt480] [Citation(s) in RCA: 301] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Emerging evidence indicates that cancer is primarily a metabolic disease involving disturbances in energy production through respiration and fermentation. The genomic instability observed in tumor cells and all other recognized hallmarks of cancer are considered downstream epiphenomena of the initial disturbance of cellular energy metabolism. The disturbances in tumor cell energy metabolism can be linked to abnormalities in the structure and function of the mitochondria. When viewed as a mitochondrial metabolic disease, the evolutionary theory of Lamarck can better explain cancer progression than can the evolutionary theory of Darwin. Cancer growth and progression can be managed following a whole body transition from fermentable metabolites, primarily glucose and glutamine, to respiratory metabolites, primarily ketone bodies. As each individual is a unique metabolic entity, personalization of metabolic therapy as a broad-based cancer treatment strategy will require fine-tuning to match the therapy to an individual’s unique physiology.
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Affiliation(s)
- Thomas N Seyfried
- Biology Department, Boston College, Chestnut Hill, MA 02467, USA and
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Ohba K, Sugiyama S, Sumida H, Nozaki T, Matsubara J, Matsuzawa Y, Konishi M, Akiyama E, Kurokawa H, Maeda H, Sugamura K, Nagayoshi Y, Morihisa K, Sakamoto K, Tsujita K, Yamamoto E, Yamamuro M, Kojima S, Kaikita K, Tayama S, Hokimoto S, Matsui K, Sakamoto T, Ogawa H. Microvascular coronary artery spasm presents distinctive clinical features with endothelial dysfunction as nonobstructive coronary artery disease. J Am Heart Assoc 2012; 1:e002485. [PMID: 23316292 PMCID: PMC3541613 DOI: 10.1161/jaha.112.002485] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/02/2012] [Indexed: 12/22/2022]
Abstract
Background Angina without significant stenosis, or nonobstructive coronary artery disease, attracts clinical attention. Microvascular coronary artery spasm (microvascular CAS) can cause nonobstructive coronary artery disease. We investigated the clinical features of microvascular CAS and the therapeutic efficacy of calcium channel blockers. Methods and Results Three hundred seventy consecutive, stable patients with suspected angina presenting nonobstructive coronary arteries (<50% diameter) in coronary angiography were investigated with the intracoronary acetylcholine provocation test, with simultaneous measurements of transcardiac lactate production and of changes in the quantitative coronary blood flow. We diagnosed microvascular CAS according to lactate production and a decrease in coronary blood flow without epicardial vasospasm during the acetylcholine provocation test. We prospectively followed up the patients with calcium channel blockers for microvascular coronary artery disease. We identified 50 patients with microvascular CAS who demonstrated significant impairment of the endothelium-dependent vascular response, which was assessed by coronary blood flow during the acetylcholine provocation test. Administration of isosorbide dinitrate normalized the abnormal coronary flow pattern in the patients with microvascular CAS. Multivariate logistic regression analysis indicated that female sex, a lower body mass index, minor–borderline ischemic electrocardiogram findings at rest, limited–baseline diastolic-to-systolic velocity ratio, and attenuated adenosine triphosphate–induced coronary flow reserve were independently correlated with the presence of microvascular CAS. Receiver-operating characteristics curve analysis revealed that the aforementioned 5-variable model showed good correlation with the presence of microvascular CAS (area under the curve: 0.820). No patients with microvascular CAS treated with calcium channel blockers developed cardiovascular events over 47.8±27.5 months. Conclusions Microvascular CAS causes distinctive clinical features and endothelial dysfunction that are important to recognize as nonobstructive coronary artery disease so that optimal care with calcium channel blockers can be provided. Clinical Trial Registration URL: www.umin.ac.jp/ctr. Unique identifier: UMIN000003839.
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Affiliation(s)
- Keisuke Ohba
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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9
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Everse J, Kaplan NO. Lactate dehydrogenases: structure and function. ADVANCES IN ENZYMOLOGY AND RELATED AREAS OF MOLECULAR BIOLOGY 2006; 37:61-133. [PMID: 4144036 DOI: 10.1002/9780470122822.ch2] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kemppainen J, Fujimoto T, Kalliokoski KK, Viljanen T, Nuutila P, Knuuti J. Myocardial and skeletal muscle glucose uptake during exercise in humans. J Physiol 2002; 542:403-12. [PMID: 12122141 PMCID: PMC2290432 DOI: 10.1113/jphysiol.2002.018135] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to investigate the effects of exercise on myocardial glucose uptake and whether the pattern of glucose uptake is the same as in skeletal muscle. Glucose uptake was measured using positron emission tomography (PET) and 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG). Twelve healthy men were studied during rest, while 14 subjects were studied after 35 min of bicycle exercise corresponding to 30, 55 and 75 % of maximal oxygen consumption (*VO2,max)) on three separate days. [(18)F]FDG was injected 10 min after the start of exercise and exercise continued for a further 25 min. Myocardial and skeletal muscle PET scanning was commenced directly after the completion of the exercise bout. As compared to the resting state, exercise doubled myocardial glucose uptake at the 30 % (P = 0.056) and 55 % intensity levels (P < 0.05), while at the 75 % intensity level glucose uptake was reduced significantly compared to the lower exercise intensities. There was no significant difference between the highest intensity level and the resting state (P = 0.18). At rest and during low-intensity exercise, myocardial glucose uptake was inversely associated with circulating levels of free fatty acids. However, during higher exercise intensities when plasma lactate concentrations increased significantly, this association disappeared. In contrast to myocardial responses, skeletal muscle glucose uptake rose in parallel with exercise intensity from rest to 30 % and then 55 % *VO2,max) (P < 0.001) and tended to increase further at the intensity of 75 % *VO2,max) (P = 0.065). In conclusion, these results demonstrate that myocardial glucose uptake is increased during mild- and moderate-intensity exercise, but is decreased during high-intensity exercise. This finding suggests that the increased myocardial energy that is needed during high-intensity exercise is supplied by substrates other than glucose.
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Affiliation(s)
- Jukka Kemppainen
- Turku PET Centre, University of Turku, PO Box 52, 20521 Turku, Finland
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11
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Crittenden MD. Intraoperative metabolic monitoring of the heart: I. Clinical assessment of coronary sinus metabolites. Ann Thorac Surg 2001; 72:S2220-6; discussion S2267-70. [PMID: 11789845 DOI: 10.1016/s0003-4975(01)03296-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Numerous clinical studies have corroborated the ability of intraoperative sampling of coronary sinus blood to measure changes in myocardial metabolism induced by ischemia and reperfusion. Among other changes, cardiac arrest induces a period of obligate myocardial lactate production that persists for an indeterminate amount of time after reperfusion. Coronary sinus lactate assays have been established as a standard method to compare various myocardial protection strategies. Current methodology requires detailed sample processing, precluding real-time feedback in the operating room. Newer devices hold promise in allowing the online assessment of myocardial metabolism; however, these methods await precise validation.
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Affiliation(s)
- M D Crittenden
- Department of Surgery, VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA.
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12
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Yamauchi H. Efficacy of leukocyte-depleted terminal blood cardioplegia in congenital heart disease. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:435-9. [PMID: 10965616 DOI: 10.1007/bf03218171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
OBJECTIVE Activated leukocytes and their products play a significant role in reperfusion injury and cause microvascular occlusion--the 'no-reflow phenomenon'--which decreases coronary blood flow after the release of the aortic cross-clamp during open-heart surgery. This study was designed to evaluate the efficacy of leukocyte-depleted terminal blood cardioplegia in patients with right ventricular pressure or volume overloaded congenital heart disease undergoing intracardiac repair. SUBJECTS AND METHODS Fourteen infants and children undergoing intracardiac repair for congenital heart defects were the subjects in this study. Leukocyte-depleted terminal blood cardioplegia was employed in seven patients (Group I). For the control, terminal blood cardioplegia with leukocytes was employed in seven patients (Group II). In order to evaluate the myocardial anaerobic metabolism, the arteriovenous difference in the pyruvate and lactate levels was compared between both groups. Blood samples were taken simultaneously from both the arterial limb of the bypass circuit and the coronary sinus immediately after, and at 5, 10, and at 20 minutes after, the release of the aortic cross-clamp. RESULTS The coronary arteriovenous difference in the pyruvate and lactate levels demonstrated that the myocardial anaerobic metabolism in Group II was significantly higher than in Group I. The delta excess lactate demonstrated that myocardial hypoxia in Group II persisted significantly longer than in Group I. There was a tendency for the creatine kinase-MB level at 6 hr after surgery to be lower in Group I than in Group II. CONCLUSION Leukocyte-depleted terminal blood cardioplegia may reduce the myocardial anaerobic metabolism in patients with right ventricular pressure or volume overloaded congenital heart disease undergoing intracardiac repair.
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Affiliation(s)
- H Yamauchi
- Department of Surgery II, Nippon Medical School, Tokyo, Japan
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13
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Sonnenblick EH. Richard Gorlin. Clin Cardiol 1998. [DOI: 10.1002/clc.4960211119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Sequential Alterations in Myocardial Lactate Metabolism, S-T Segments, and Left Ventricular Function During Angina Induced by Atrial Pacing. Ann Noninvasive Electrocardiol 1997. [DOI: 10.1111/j.1542-474x.1997.tb00206.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Christensen CW, Rosen LB, Gal RA, Haseeb M, Lassar TA, Port SC. Coronary vasodilator reserve. Comparison of the effects of papaverine and adenosine on coronary flow, ventricular function, and myocardial metabolism. Circulation 1991; 83:294-303. [PMID: 1984887 DOI: 10.1161/01.cir.83.1.294] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To evaluate coronary flow reserve during cardiac catheterization, intracoronary adenosine and papaverine have been used in the clinical setting. Although papaverine maximizes coronary blood flow, it induces several toxic side effects that reduce its desirability as a coronary dilator. This investigation was designed to compare the subselective intracoronary administration of papaverine with that of adenosine in an animal model. In dogs (n = 34), we studied the effects of each agent on hemodynamics, regional myocardial blood flow, contractility (sonomicrometric and echocardiographic), metabolism (coronary arterial and venous lactate and tissue high-energy phosphates), and electrocardiographic (ST and QT intervals) parameters. Barbiturate and morphine anesthesia/analgesia was induced, and a left thoracotomy was performed. An arterial shunt was created from the left carotid artery to the left anterior descending coronary artery. Two separate groups were studied: group 1 (n = 16) for regional myocardial blood flow and mechanical function and group 2 (n = 18) for biochemical measurements. Adenosine (67 +/- 2 micrograms/min) or papaverine (6 +/- 1 mg/min) was infused into the coronary shunt at a rate of 0.5 + 0.1 ml/min for a maximum duration of 3.5 minutes. Regional myocardial blood flows were determined at control (predrug) and maximal coronary flow using radiolabeled microspheres. All hemodynamic, wall motion, biochemical, and electrocardiographic parameters were also measured at these times. Both drugs produced comparable increases in total and regional coronary blood flows (adenosine, 1.21 +/- 0.15 to 4.83 +/- 0.36 ml/min/g; papaverine, 1.21 +/- 0.05 to 4.89 +/- 0.28 ml/min/g) upon infusion into the left anterior descending coronary artery. Papaverine produced significant (p less than 0.05) changes in subendocardial ST segment electrocardiogram (-2.5 mm), QT prolongation (8 +/- 2%), myocardial creatine phosphate (47% decrease), and coronary sinus serum lactate (277% increase) compared with control. In addition, intracoronary papaverine induced an abnormal contractile pattern. No significant changes in any of these parameters (i.e., ST segment, QT prolongation, myocardial creatine phosphate level, or lactate level) were observed with intracoronary adenosine infusions. We conclude that intracoronary adenosine is comparable to papaverine for maximizing coronary blood flow without the deleterious properties observed with intracoronary papaverine.
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Affiliation(s)
- C W Christensen
- Department of Medicine, University of Wisconsin Medical School, Sinai Samaritan Medical Center, Milwaukee 53233
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Carter J, Reynoldson JA, Harper CM, Heywood LH, Thorburn GD. Lack of production of thromboxane A2 by the sheep heart following coronary occlusion. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY. C, COMPARATIVE PHARMACOLOGY AND TOXICOLOGY 1986; 83:387-92. [PMID: 2872003 DOI: 10.1016/0742-8413(86)90141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Blood pressure, heart rate and ECG were monitored continuously and coronary venous blood samples assayed for thromboxane B2. Arterio-coronary venous lactic acid differences were estimated. In anaesthetized sheep, 60 sec occlusions of the left circumflex coronary artery caused hypotension with little change in heart rate. Five minute occlusions produced similar changes accompanied by cardiac arrhythmias and a larger fall in blood pressure. In conscious sheep heart rate rose and blood pressure was maintained. ECG and lactic acid changes indicated severe myocardial ischaemia but not change in thromboxane release was detected. The apparent lack of involvement of thromboxane may reflect a relative inability of sheep platelets to produce this substance or a failure to provide an adequate stimulus for synthesis.
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Cohen MV, Greenberg MA, Grose R, Yipintsoi T. Cardiac tamponade in dogs with normal coronary arteries. II. Myocardial flow and metabolism with moderate and severe hemodynamic impairment. Basic Res Cardiol 1984; 79:542-50. [PMID: 6508712 DOI: 10.1007/bf01910483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To determine the effects of cardiac tamponade on myocardial blood flow and its distribution, dogs were prepared with indwelling pericardial catheters. Hemodynamic, myocardial blood flow, and myocardial metabolic data were collected in 5 closed-chest, spontaneously breathing animals with normal blood volumes and hemoglobin concentrations and 6 with acute anemia. Instillation of an average of 89.0 +/- 14.9 ml of modified Normosol into the pericardial space in dogs with normal hemoglobin levels produced mild tamponade with a modest decline in aortic pressure (119.5 +/- 14.3 to 96.8 +/- 12.1 mm Hg) and significant rises in left and right atrial and pericardial pressures to 7-8 mm Hg. Increasing the pericardial volume to 124.0 +/- 13.6 ml produced hypotension (mean aortic pressure 86.2 +/- 10.5 mm Hg) and rises in the left and right ventricular filling pressures and pericardial pressure to 10-11 mm Hg. Total myocardial blood flow fell from 1.19 +/- 0.18 to 0.73 +/- 0.17 ml/min/g (p less than 0.02) during mild tamponade, and fell further to 0.56 +/- 0.17 ml/min/g (p less than 0.05) with more severe tamponade. Despite these declines, the left ventricular wall inner/outer flow ratio and left ventricular flow as a proportion of total cardiac output were unchanged. In dogs with anemia more severe tamponade was created, with consequently more marked hemodynamic abnormalities. However, the relative changes in myocardial blood flow and inner/outer flow ratio were similar. Myocardial metabolic parameters could be evaluated only in the dogs with less severe tamponade.(ABSTRACT TRUNCATED AT 250 WORDS)
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Cuddihee RW, Fonda ML. Concentrations of lactate and pyruvate and temperature effects on lactate dehydrogenase activity in the tissues of the big brown bat (Eptesicus fuscus) during arousal from hibernation. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY. B, COMPARATIVE BIOCHEMISTRY 1982; 73:1001-9. [PMID: 7151414 DOI: 10.1016/0305-0491(82)90350-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
1. The rectal temperatures, steady state concentrations of lactate and pyruvate, and the LDH isoenzyme composition in the heart, liver, and pectoral muscle of hibernating and arousing Eptesicus fuscus were measured. 2. Bat rectal temperature increased from 8.86 to 33.1 degrees C during arousal. 3. During arousal, steady state concentrations of pyruvate and lactate increased significantly in the tissues, however they remained generally below the level necessary to saturate LDH at the respective temperature. 4. The activities of the two LDH isoenzymes, M4, the predominant form in bat liver, and H4, the main form in bat heart and pectoral muscle, show substrate-dependent temperature effects described by the equation, mu = (E beta S + E alpha K t)/(K t + S). 5. Temperature effects (mu) on bat LDH activity increased during arousal but remained significantly lower than mu determined at saturating concentrations of substrate (E beta). 6. The parameters E beta-E alpha, E alpha and K tau are particularly important in describing the temperature dependence of LDH activity in tissues of the arousing bat.
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Christie LG, Conti CR. Systematic approach to evaluation of angina-like chest pain: pathophysiology and clinical testing with emphasis on objective documentation of myocardial ischemia. Am Heart J 1981; 102:897-912. [PMID: 7304398 DOI: 10.1016/0002-8703(81)90042-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Edlund A, Wennmalm A. Oxygen consumption in rabbit Langendorff hearts perfused with a saline medium. ACTA PHYSIOLOGICA SCANDINAVICA 1981; 113:117-22. [PMID: 7315433 DOI: 10.1111/j.1748-1716.1981.tb06870.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Isolated rabbit hearts were perfused according to Langendorff at a temperature of 38 degrees C and a pressure of 5.9 kPa with gassed Tyrode solution. Gas mixtures containing 5% CO2 and 15, 20, 30, 60, or 95% O2 in N2 were used to saturate the perfusion medium. In some cases lactate (50 or 500 microM) was present in the medium perfusing the heart. Coronary flow (CF), oxygen pressure in the perfusion medium and in the cardiac effluent and lactate in the effluent were analysed in all experiments. The oxygen uptake in the hearts perfused with a medium equilibrated at atmospheric pressure with 95% O2 and 5% CO2 (oxygen pressure approximately 87 kPa, oxygen content 19 ml X 1(-1)), averaged 3 ml X 100 g w.w. -1 X min-1. Reduction of the oxygen pressure in the perfusion medium resulted in an increase in CF and in the fractional extraction of oxygen from the medium, making it possible to maintain the heart's oxygen uptake (VO2) down to an oxygen pressure in the perfusion medium of about 24 kPa (oxygen content approximately 5 ml X 1(-1), the perfusion medium equilibrated with 20% O2 and 5% CO2 in N2). Myocardial lactate production was low during perfusion at pO2 approximately 87 kPa but increased rapidly when the oxygen pressure was lowered. The addition of lactate (500 microM) to the perfusion medium at pO2 approximately 87 kP induced a fractional uptake of about 20%. It is concluded that the VO2 observed during perfusion at pO2 approximately 87 kPa mainly reflects aerobic myocardial metabolism in this preparation. This assumption is based on the facts that coronary flow and fractional oxygen extraction are submaximal and that a considerable uptake of lactate occurs concurrently with a very limited production. However, even moderate reduction of the oxygen pressure in the perfusion medium (to approximately 61 kPa) is followed by a significant increase in lactate production, indicating that myocardial oxygenation is inefficient.
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Rude RE, Turi Z, Brown EJ, Lorell BH, Colucci WS, Mudge GH, Taylor CR, Grossman W. Acute effects of oral pirbuterol on myocardial oxygen metabolism and systemic hemodynamics in chronic congestive heart failure. Circulation 1981; 64:139-45. [PMID: 7237712 DOI: 10.1161/01.cir.64.1.139] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Pirbuterol hydrochloride, an orally effective beta-adrenergic agonist, improves hemodynamic abnormalities in patients with congestive heart failure, but its effects on myocardial oxygen consumption (MVO2) and coronary blood flow have not been characterized. We studied the effects of 20-30 mg of oral pirbuterol on myocardial metabolic and hemodynamic parameters in 12 patients (six with coronary artery disease) with chronic CHF refractory to standard medical therapy. Pirbuterol induced an increase in cardiac index (1.7 +/- 0.1 to 2.3 +/- 0.2 l/min/m2, p less than 0.05) and a fall in systemic vascular resistance (1884 +/- 118 to 1391 +/- 69 dyn-sec-cm-5, p less than 0.01) 2 hours after administration. Pulmonary capillary wedge pressure fell from arterial and right atrial pressures did not change. Heart rate remained constant. Arterial-coronary sinus oxygen content difference narrowed (from 12.9 +/- 0.4 to 11.1 +/- 0.3 vol%, p less than 0.05), while no significant change occurred in MVO2. Myocardial oxygen extraction ratio and myocardial lactate extraction ratio did not change, and no patient developed angina or electrocardiographic evidence of myocardial ischemia. Patients with coronary artery disease had hemodynamic and myocardial metabolic responses similar to those without coronary artery disease. Pirbuterol effects substantial acute hemodynamic improvement in patients with chronic congestive heart failure without increasing requirements for coronary blood flow or myocardial oxygen delivery and without provoking myocardial ischemia.
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Abstract
Previous studies have demonstrated competition between sympathetic alpha receptor-mediated coronary vasoconstriction and local metabolic vasodilation during sympathetic activation. The present study tested if this competition also occurs in the presence of coronary stenosis. In closed-chest dogs, the left coronary artery was cannulated, and blood flow from the aorta was restricted by a moderate stenosis (70% area reduction). Intracoronary norepinephrine infusion produced coronary vascular alpha receptor and myocardial beta receptor activation. Norepinephrine infusion was repeated following alpha receptor blockade with phenoxybenzamine (0.25 mg/kg, injected into the coronary artery). Myocardial oxygen and lactate extraction, coronary sinus blood oxygen tension, and coronary resistance were compared at equal levels of myocardial oxygen consumption before and after coronary alpha receptor blockade. In the presence of coronary stenosis, intracoronary norepinephrine infusion decreased coronary sinus oxygen content and increased myocardial oxygen extraction. At comparable myocardial oxygen consumptions coronary vascular resistance was greater with alpha receptors intact than after alpha receptor blockade. The increase in myocardial oxygen extraction was prevented by alpha receptor blockade. We conclude that a sympathetic alpha receptor-mediated coronary vasoconstrictor influence operates, even in the presence of coronary stenosis, to limit oxygen delivery to the heart and increase myocardial oxygen extraction up to the point of cardiac failure, but that this vasoconstrictor effect does not result in net myocardial lactate production.
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Lewy RI, Wiener L, Walinsky P, Lefer AM, Silver MJ, Smith JB. Thromboxane release during pacing-induced angina pectoris: possible vasoconstrictor influence on the coronary vasculature. Circulation 1980; 61:1165-71. [PMID: 7371128 DOI: 10.1161/01.cir.61.6.1165] [Citation(s) in RCA: 188] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Gertz EW, Wisneski JA, Neese R, Houser A, Korte R, Bristow JD. Myocardial lactate extraction: multi-determined metabolic function. Circulation 1980; 61:256-61. [PMID: 7351050 DOI: 10.1161/01.cir.61.2.256] [Citation(s) in RCA: 100] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Myocardial lactate production indicates anaerobic metabolism resulting from hypoxia or anoxia. Clinically, myocardial lactate extraction of less than 10% has also been used as an indicator of ischemia. Sixteen healthy young male volunteers underwent coronary sinus and aterial catheterization. A coronary sinus pacing catheter was used to obtain blood samples and increase the heart rate to twice the resting rate. Hemodynamic measurements and blood samples for lactate, free fatty acids and glucose were obtained at rest and during pacing. Seven of 16 sujects (44%) had lactate extraction of less than 10% at rest and/or at miximal pacing. No subject produced lactate. There was no correlation between myocardial lactate extraction and arterial glucose. However, lactate extraction correlated inversely with the arterial levels of free fatty acids (r = 0.67; p less than 0.01). In addition, a positive correlation was present between lactate extraction and the arterial lactate level (r = 0.78; p less than 0.01). In conclusion, myocardial lactate extraction is dependent on multiple metabolic parameters and any absolute value short of production cannot be considered abnormal.
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28
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Mazareán HH, Dux L, Guba F. Changes of metabolism during experimentally induced myotonia of rats. I. Alterations in lactate and malate dehydrogenase isoenzyme activities. BIOCHEMICAL MEDICINE 1979; 22:350-8. [PMID: 533541 DOI: 10.1016/0006-2944(79)90022-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Weber KT, Janicki JS. The metabolic demand and oxygen supply of the heart: physiologic and clinical considerations. Am J Cardiol 1979; 44:722-9. [PMID: 484502 DOI: 10.1016/0002-9149(79)90294-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Wiener L, Walinsky P, Kasparian H, Duca PR, Gottlieb RS, Hanckel F, Templeton JY, Brest AN. Therapeutic implications of myocardial lactate metabolism in patients considered candidates for emergency myocardial revascularization. J Thorac Cardiovasc Surg 1978. [DOI: 10.1016/s0022-5223(19)41250-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Berger HJ, Zaret BL, Speroff L, Cohen LS, Wolfson S. Cardiac prostaglandin release during myocardial ischemia induced by atrial pacing in patients with coronary artery disease. Am J Cardiol 1977; 39:481-6. [PMID: 848431 DOI: 10.1016/s0002-9149(77)80154-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The relation between myocardial release of prostaglandin and myocardial ischemia was studied in 12 selected patients with multivessel coronary artery disease. These 12 were chosen for analysis because they experienced angina pectoris, ischemic electrocardiographic changes and decreased myocardial lactate uptake during atrial pacing. Simultaneous aortic and coronary sinus blood samples were obtained at rest, during angina and after recovery and were assayed for prostaglandins F, E and A with radioimmunoassay. Cardiac release of prostaglandin F was observed during angina in 11 of 12 patients. Aortic prostaglandin levels remained constant throught each study. During angina, the mean aortovenous difference (+/- standard error) was -0.30 +/- 0.04 ng/ml (P less than 0.001) for prostaglandin F and -0.10 +/- 0.03 ng/ml (Pless than 0.001) for prostaglandin E. There was no significant release of prostaglandin A. Blood samples were also drawn at subanginal heart rates in two patients. Prostaglandin F was released only during angina. In three control patients with a chest pain syndrome and normal coronary arteries, comparable atrial pacing produced no release of prostaglandin F, E or A. These results, together with the known vascular and metabolic actions of prostaglandins, suggest that these pharmacologically active compounds may also play a physiologic role in the cardiac response to ischemia in man.
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Effect of sodium succinate on some indices of carbohydrate metabolism of the ischemic myocardium. Bull Exp Biol Med 1976. [DOI: 10.1007/bf00785698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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DeMots H, Rahimtoola SH, Kremkau EL, Bennett W, Mahler D. Effects of ouabain on myocardial oxygen supply and demand in patients with chronic coronary artery disease. A hemodynamic, volumetric, and metabolic study in patients without heart failure. J Clin Invest 1976; 58:312-9. [PMID: 783197 PMCID: PMC333185 DOI: 10.1172/jci108474] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The effects of digitalis glycosides on myocardial oxygen supply and demand are of particular interest in the presence of obstructive coronary artery disease, but have not been measured previously in man. We assessed the effects of ouabain (0.015 mg/kg body weight) on hemodynamic, volumetric, and metabolic parameters in 11 patients with severe chronic coronary artery disease without clinical congestive heart failure. Because the protocol was long and involved interventions which might affect the determinations, we also studied in nine patients using an identical protocol except that ouabain administration was omitted. Left ventricular end-diastolic pressure and left ventricular end-diastolic volume fell in each patient given ouabain, even though they were initially elevated in only two patients. Left ventricular end-diastolic pressure fell from 11.5+/-1.4 (mean+/-SE) to 5.6+/-0.9 mm Hg (P less than 0.001) and left ventricular end-diastolic volume fell from 100+/-17 to 82+/-12 ml/m2 (P less than 0.01) 1 h after ouabain infusion was completed. The maximum velocity of contractile element shortening increased from 1.68+/-0.11 ml/s to 2.18+/-0.21 muscle-lengths/s (P less than 0.05) and is consistent with an increase in contractility. No significant change in these parameters occurred in the control patients. No significant change in myocardial oxygen consumption occurred after ouabain administration but this may be related to a greater decrease in mean arterial pressure in the ouabain patients than in the control patients. We conclude that in patients with chronic coronary artery disease who are not in clinical congestive heart failure left ventricular end-diastolic volume falls after ouabain administration even when it is initially normal. Though this fall would be associated with a decrease in wall tension, and, therefore, of myocardial oxygen consumption, it may not be of sufficient magnitude to prevent a net increase in myocardial oxygen consumption. Nevertheless, compensatory mechanisms prevent a deterioration of resting myocardial metabolism.
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Natarajan G, Nakhjavan FK, Kahn D, Yazdanfar S, Sahibzada W, Khawaja F, Goldberg H. Myocardial metabolic studies in prolapsing mitral leaflet syndrome. Circulation 1975; 52:1105-10. [PMID: 1182956 DOI: 10.1161/01.cir.52.6.1105] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patients with prolapsing mitral leaflet syndrome (PML) frequently have chest pain of undetermined etiology. Twenty-three patients with PML underwent cardiac hemodynamic, angiographic, and metabolic studies. The latter were performed during control spontaneous heart rate and tachycardia by right atrial pacing. Myocardial supply-demand ratio (DPTI:SPTI) was estimated from the planimetric integration of the diastolic area (diastolic pressure time index = DPTI) and systolic area (systolic pressure time index = SPTI) of the central aortic pressure. Chest pain during pacing occurred in five patients. In two patients, it was associated with ST depression typical of ischemia on the electrocardiogram. Myocardial lactate abnormalities (lactate production or less than 10% extraction) occurred in seven patients during pacing tachycardia and was present in two patients during control state. DPTI:SPTI ratio during control state was 1.22 (+/- 0.07 SE) and decreased to 0.85 (+/- 0.05 SE) during pacing tachycardia. It is concluded that the myocardial lactate abnormalities in PML, which were present in approximately 30% of the patients in the present series, are most likely due to myocardial hypoxia. Whether or not the hypoxia is secondary to "small vessel disease" is not elucidated by this study.
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Vokonas PS, Cohn PF, Klein MD, Laver MB, Gorlin R. Hemoglobin affinity for oxygen in the anginal syndrome with normal coronary arteriograms. J Clin Invest 1974; 54:409-15. [PMID: 4847250 PMCID: PMC301568 DOI: 10.1172/jci107776] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Oxyhemoglobin dissociation (OHD) curves were performed on whole blood (WB) from 20 patients with anginal pain, normal hemodynamics, and normal coronary arteries, as demonstrated by selective coronary cinearteriography. OHD curves in 19 of 20 patients, from zero to full saturation, were nearly identical to those in normal control subjects with values for P(50) (Po(2) at 50% saturation and pH 7.4) of 26.7+/-1.5 (mean+/-SD of the mean) torr (mm Hg) and red blood cell (RBC) levels of 2,3-diphosphoglyceric acid (2, 3-DPG) of 0.72+/-0.10 (mean+/-SD of the mean) M/M hemoglobin (Hb). Normal values for nonsmoking adults were: P(50), 26.6+/-1.4 (mean+/-SD of the mean) torr: and RBC 2,3-DPG, 0.81+/-0.09 (mean+/-SD of the mean) M/M Hb. Mean levels of carbon monoxide were normal at 0.14+/-0.01 (mean+/-SEM) ml/100 ml WB in 10 patients who were nonsmokers and 0.45+/-0.15 (mean+/-SEM) ml/100 ml WB in 10 smokers. In one patient, a heavy smoker with markedly elevated blood carbon monoxide levels, an abnormal leftward shift of the OHD curve was observed. This was corrected after discontinuation of smoking. In utilizing these methods, we could not detect consistent abnormalities of Hb affinity for oxygen at rest in the patients studied, which suggests that a defect in oxygen transport at rest is an unlikely explanation for the symptoms of chest pain in patients with the anginal syndrome and normal coronary arteriograms.
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Lesch M, Teichholz LE, Soeldner JS, Gorlin R. Ineffectiveness of glucose, potassium, and insulin infusion during pacing stress in chronic ischemic heart disease. Circulation 1974; 49:1028-37. [PMID: 4598631 DOI: 10.1161/01.cir.49.6.1028] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Eight patients with coronary artery disease and positive exercise electrocardiograms undergoing cardiac catheterization were subjected to periods of atrial pacing-induced tachycardia at identical rates, before and during a glucose, potassium, and insulin (GKI) infusion. Steady state elevation of glucose and insulin was obtained prior to repeating the atrial pacing test in the GKI state. With each patient serving as his own control, five developed augmented clinical signs of acute ischemia during the paced GKI state, two no change, and one subjective improvement. Left ventricular end-diastolic pressure (LVEDP) was elevated in all patients (1-8 mm Hg) at rest during GKI infusion as compared to the rest control state. LVEDP during pacing was greater during the GKI paced state as compared to the control paced state in three of the eight patients whereas after pacing LVEDP was higher in four of eight patients during GKI. ST-segment depression was less during pacing in the GKI as compared to control state in four patients. A decrease in ST-segment depression was noted in two patients after pacing in the GKI state as compared to this measure after pacing in the control state. Augmented myocardial glucose uptake was demonstrated in the paced GKI state but lactate analysis failed to demonstrate a stoichiometric relationship between enhanced glucose uptake and lactate production.
It is concluded that tolerance to ischemia is not extended and in the majority of cases may be adversely affected by GKI.
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Wisheart JD, Archie JP, Kirklin JW, Tracy WG. Myocardial blood flow and oxygen consumption in man early after valve replacement. Circulation 1974; 49:933-42. [PMID: 4597568 DOI: 10.1161/01.cir.49.5.933] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Twenty-one patients without demonstrable coronary artery disease have been studied in the first 48 hours after aortic or mitral valve replacement to determine the possible contribution of abnormalities of left ventricular myocardial blood flow and oxygen consumption to the impaired cardiac performance which is sometimes evident in such patients. In the 14 patients making an uneventful recovery (group A), the mean value for left ventricular coronary blood flow (Kety-Schmidt method) in each study period was between 105.9 and 111.2 ml·min
–1
·100 g
–1
, and myocardial oxygen consumption between 11.1 and 12.7 ml·min
–1
·100 g
–1
, both being higher than in normal resting man. Oxygen extraction was 59 to 69%, and coronary sinus oxygen tension 23 to 29 mm Hg. Lactate extraction was normal. Five patients (group B) required pharmacologic support because of low cardiac output; all had undergone mitral valve replacement. In them, left ventricular coronary blood flow and oxygen consumption were the same as in group A; however, oxygen extraction was greater (68 to 79%), coronary sinus oxygen tension lower (22 to 24 mm Hg) and lactate extraction lower. Patients in group A who underwent mitral replacement (N = 4) had systemic and coronary hemodynamics and metabolism that were as satisfactory as those undergoing aortic replacement, except that left atrial pressure was higher in the first study period. When heart rate was increased from 100 to 128 beats/minute by pacing in five patients in group A, and in two additional patients, myocardial oxygen consumption increased significantly, but in four patients coronary blood flow failed to increase, oxygen extraction increased, and coronary sinus oxygen levels decreased. We conclude that in patients such as those we studied, low cardiac output postoperatively is not the result of low total left ventricular coronary blood flow or myocardial oxygen supply, but may occur in some of these patients at this time from low or absent coronary reserve and added stresses such as those from tachycardia may be met only with the potentially detrimental mechanism of increasing oxygen extraction and reducing coronary venous and myocardial oxygen levels.
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Heinle RA, Levy RI, Gorlin R. Effects of factors predisposing to atherosclerosis on formation of coronary collateral vessels. Am J Cardiol 1974; 33:12-6. [PMID: 4808550 DOI: 10.1016/0002-9149(74)90733-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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40
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Opie LH, Owen P, Thomas M, Samson R. Coronary sinus lactate measurements in assessment of myocardial ischemia. Comparison with changes in lactate-pyruvate and beta-hydroxybutyrate-acetoacetate ratios and with release of hydrogen, phosphate and potassium ions from the heart. Am J Cardiol 1973; 32:295-305. [PMID: 4725585 DOI: 10.1016/s0002-9149(73)80137-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Livesley B, Oram S. Diagnosis of doubtful angina. Comparison of radiotelemetric exercise electrocardiogram with lactate content of coronary-sinus blood after pacing. Lancet 1973; 1:1461-5. [PMID: 4123136 DOI: 10.1016/s0140-6736(73)91807-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Chazov E, Smirnov VN, Mazaev AV, Asafov GB, Gukowski DU, Krikov VI. Myocardial ammonia metabolism in patients with heart disease as revealed by coronary sinus catheterization study. Circulation 1973; 47:1327-34. [PMID: 4709548 DOI: 10.1161/01.cir.47.6.1327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kemp HG, Vokonas PS, Cohn PF, Gorlin R. The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. Am J Med 1973; 54:735-42. [PMID: 4196179 DOI: 10.1016/0002-9343(73)90060-0] [Citation(s) in RCA: 332] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Significant progression of coronary artery disease was seen in 52% of subjects studied by selective cinearteriography at intervals between 2 and 75 months (average 23.8). Subsequent progression, although confined to proximal areas, was independent of overall severity of initial disease or previous disease at the site of progression and occurred frequently in previously normal vessels. Plasma lipid abnormalities and myocardial lactate production at the time of the initial study were significantly associated with subsequent arteriographic progression. Similarly abnormal glucose tolerance was seen more frequently in patients exhibiting progression than in those who did not. The progression occurring in patients with lipid abnormalities was more severe and more widespread than in other patients, and apparent interval reduction in lipid values did not influence the ultimate course of the atheromatous process. Myocardial infarction was almost invariably associated with progression. Collateral coronary circulation never increased or appeared unless accompanied by an increase in the extent of local coronary artery disease. The absence of progression was associated with a favorable prognosis. All other clinical, laboratory, and arteriographic parameters analyzed were not predictive of subsequent progression of the coronary obstructive lesion.
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Smullens SN, Wiener L, Kasparian H, Brest AN, Bacharach B, Noble PH, Templeton JY. Evaluation and surgical management of acute evolving myocardial infarction. J Thorac Cardiovasc Surg 1972. [DOI: 10.1016/s0022-5223(19)39706-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Opie LH, Thomas M, Owen P, Shulman G. Increased coronary venous inorganic phosphate concentrations during experimental myocardial ischemia. Am J Cardiol 1972; 30:503-13. [PMID: 5073663 DOI: 10.1016/0002-9149(72)90041-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Cannon PJ, Dell RB, Dwyer EM. Regional myocardial perfusion rates in patient with coronary artery disease. J Clin Invest 1972; 51:978-94. [PMID: 5062613 PMCID: PMC302211 DOI: 10.1172/jci106892] [Citation(s) in RCA: 87] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Regional myocardial perfusion rates were estimated from the myocardial washout of (133)Xenon in 24 patients with heart disease whose coronary arteriograms were abnormal and 17 similar subjects whose coronary arteriograms were judged to be normal. Disappearance rates of (133)Xe from multiple areas of the heart were monitored externally with a multiple-crystal scintillation camera after the isotope had been injected into a coronary artery and local myocardial perfusion rates were calculated by the Kety formula. The mean myocardial perfusion rates in the left ventricle exceeded those in the right ventricle or atrial regions in subjects without demonstrable coronary artery disease. In this group there was a significant lack of homogeneity of local perfusion rates in left ventricular myocardium; the mean coefficient of variation of left ventricular local perfusion rates was 15.8%. In the patients with radiographically demonstrable coronary artery disease, a variety of myocardial perfusion patterns were observed. Local capillary blood flow rates were depressed throughout the myocardium of patients with diffuse coronary disease but were subnormal only in discrete myocardial regions of others with localized occlusive disease. Local myocardial perfusion rates were similar to those found in the group with normal coronary arteriograms in patients with slight degrees of coronary disease and in those areas of myocardium distal to marked coronary constrictions or occlusions which were well supplied by collateral vessels. In subjects with right coronary disease, the mean right ventricular perfusion rates were significantly subnormal; in seven subjects of this group perfusion of the inferior left ventricle by a dominant right coronary artery was absent or depressed. The average mean left ventricular perfusion rate of 12 subjects with significant disease of two or more branches of the left coronary artery was significantly lower than that of the group with normal left coronary arteriograms. In the patients with abnormal left coronary arteriograms, the average coefficient of variation of local left ventricular perfusion rates was significantly increased (24.8%). The studies provide evidence that coronary artery disease is associated with increased heterogeneity of local myocardial perfusion rates. They indicate that radiographically significant vascular pathology of the right or left coronary artery may be associated with significant reductions of myocardial capillary perfusion in the region supplied by the diseased vessel.
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