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Lactate metabolism in acute myocardial infarction and its relation to regional ventricular performance

, : Lactate metabolism in acute myocardial infarction and its relation to regional ventricular performance. Journal of the American College of Cardiology 5(6): 1283-1291

Myocardial metabolism was assessed in 20 patients with acute anterior myocardial infarction using lactate uptake (defined as (aortic lactate - great cardiac venous lactate)/aortic lactate .times. 100) as an index. The regional ejection fraction of the anterior wall was obtained from left ventriculography. There was a linear relation between lactate uptake and regional ejection (r = 0.79, P < 0.001). Four patients without total occlusion in the infarct vessel had a higher lactate uptake (19.6 .+-. 6.7 vs. 4.2 .+-. 13.4%, P < 0.05) and regional ejection fraction (26.3 .+-. 7.9 vs. 14.9 .+-. 7.0%, P < 0.05) than did 6 patients with total occlusion. The latter group of patients underwent intracoronary infusion of urokinase, which resulted in reperfusion in 13 patients. Lactate uptake before urokinase infusion (sample I), just after reperfusion (sample II), 30 min after reperfusion (sample III) and 4 wk after reperfusion (sample IV) was 5.7 .+-. 13.2, -13.9 .+-. 14.7, 2.9 .+-. 15.2 and 20.2 .+-. 11.0%, respectively, (sample I vs. II and II vs. III, P < 0.01; sample I vs. IV and III vs. IV, P < 0.05). The decrease in lactate uptake immediately after reperfusion, which was accompanied by an increase in creatine kinase-MB isoenzyme release into the blood, was considered to be the result of a "washout" effect. Lactate uptake was ameliorated 4 wk later, accompanied by an improvement (from 15.1 .+-. 7.1 to 23.4 .+-. 7.2%, P < 0.01) in the regional ejection fraction. The degree of asynergy was closely related to the extent of metabolic deterioration in myocardial infarction.


PMID: 3998312

DOI: 10.1016/s0735-1097(85)80338-7

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