© 2003 European Society of Cardiology
Improved systolic and diastolic myocardial function with intracoronary pyruvate in patients with congestive heart failure
Abteilung Kardiologie und Pneumologie Georg-August-Universität Göttingen, Robert-Koch-Str. 40, Göttingen D-37075, Germany
* Corresponding author. Tel.: +49-551-392920; fax: +49-551-398918. E-mail address: phermann{at}med.uni-goettingen.de
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Abstract |
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Background: Pyruvate increases myocardial performance in isolated myocardium and improves hemodynamics in patients with congestive heart failure.
Aims: To investigate the influence of pyruvate on detailed parameters of systolic and diastolic left ventricular (LV) function.
Methods and Results: In patients with heart failure due to dilated cardiomyopathy (LVEF 30±4%, n=9) pyruvate was infused intracoronarily. LV function was analysed before, during and after application of different pyruvate concentrations using a LV-micromanometer catheter. LV volumes were determined using cine ventriculography. Pyruvate increased maximum rate of LV isovolumic pressure rise (Peak +dP/dt) from 802±106 to 1125±103 mmHg/s (P<0.05). Left ventricular end-diastolic pressure declined in parallel from 17±2 to 12±2 mmHg (P<0.05) and heart rate decreased from 79±4 to 72±5 min–1 (P<0.05). Stroke volume index increased from 34±4 to 43±6 ml/m2 (P<0.05), end-diastolic LV volume remained unchanged, thus left ventricular ejection fraction increased with pyruvate from 30±4 to 39±4% (P<0.05). Maximum rate of LV isovolumic pressure decline (Peak –dP/dt) was significantly increased with pyruvate (from 794±94 to 980±108 mmHg/s; P<0.05) and mean arterial pressure increased from 80±5 to 88±4 mmHg (P<0.05). Discontinuation of pyruvate resulted in immediate reversibility of its effects.
Conclusion: Intracoronary pyruvate improves systolic and diastolic myocardial function and increases ejection fraction without increasing heart rate. Pyruvate thus exhibits the profile of a favourable inotropic agent, however, further investigation for the treatment of patients with acute heart failure is mandatory.
Key Words: Pyruvate • Inotropic agents • Heart failure • Sarcoplasmic reticulum
Received March 7, 2003; Revised June 25, 2003; Accepted October 1, 2003
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